AB0233 ASSESSMENT OF THE RESPONSE TO THERAPY WITH CSDMARDS AND BDMARDS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Vladimira Boyadzhieva, Nikolay Stoilov
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The significant economic burden of rheumatoid arthritis (RA) and new treatment options, consuming much of the healthcare resources, pay attention on appropriate management strategies. These strategies are due to the need for an adequate assessment of the response to treatment and changes if it is necessary. Currently used American College of Rheumatology (ACR) response criteria and disease activity score (DAS28-CRP) allows on time evaluation of the results and facilitate decision process when is the right time to switch patient's therapy. <h3>Objectives</h3> The aim of the study is to evaluate the effectiveness and response to the treatment with csDMARDS and/or corticosteroid and bDMARDS in patients with RA after one year follow up period using ACR 20/50/70/90 response criteria and DAS28-CRP. <h3>Methods</h3> A total of 220 patients with a mean age 55.05±10.63SD meeting the 1987 ACR classification criteria for RA were included in the study. The mean disease duration was 9.97±5.78SD. Patients were stratified according to treatment regimens into age-matched treatment groups: 96 on csDMARDs and/or corticosteroid (Sulfasalazine ? 15, Methylprednisolone ? 15, Chloroquine – 16, Methotrexate – 20, Methotrexate and Methylprednisolone –30) and 124 on bDMARD (Tocilizumab ? 30, Certolizumab pegol ? 16, Golimumab – 22, Etanercept – 20, Adalimumab – 20, Rituximab – 16). All participants were evaluated for ACR 20/50/70/90 response to therapy on 6-th and 12th month of the follow up period, DAS28-CRP was calculated via licensed calculator. Comparison was performed by analysis variance ANOVA <h3>Results</h3> The majority of patients (71%) on bDMARDS achieved ACR 50 response criteria and 16% achieved ACR 70, indicating a significantly better therapeutic effect compared to the group on csDMARDS (ACR 50 - 11% ACR 70-1%) at 6th month follow up (p &lt;0.001, p = 0.002). Only 3% of bDMARDS patients achieved ACR 90 response on the 6<sup>th</sup> month. Most of the patients on csDMARDs (64%) reach ACR 20 response criteria after the same period of therapy. At 6th month of follow-up, best response was achieved by the patients on combined MTX and corticosteroid (CS) therapy (50%) achieved ACR 20, 27% - ACR 50 and 3% - ACR 70. At the 12th month, a significant proportion of patients on bDMARDS reached the ACR 50 (36%) and ACR 70 (52%) response criteria compared to the csDMARDS group(ACR 50 – 20%, ACR 70 – 10%) (p = 0.0102; p &lt;0.001). We evaluated the response to therapy according to the DAS28-CRP categories. On baseline patients on bDMARDS had higher disease activity in comparison to patients on csDMARDS (p=0.0004). In the follow-up to the 6th month, we observed a significant reduction in the proportion of patients (on bDMARDS) with severe disease activity - 2.4%, compared to csDMARDS group - 13.5% (p = 0.0019). In 26.6% of patients on bDMARDS, we found minimal disease activity, which was significantly more than 13.5% for the csDMARDS group (p = 0.0186). A remission was found in 5.6% of patients on bDMARDS which is significantly less than 14.6% for the group on csDMARDS. In contrast to the results obtained at the 6th month of follow-up, at 12th month we observed significantly higher percentage of patients on bDMARDS who had reached the remission category - 29.8%, in comparison with csDMARDS group - 12.5%, (p = 0.0025). <h3>Conclusion</h3> Patient treated with bDMARDs showed better response to treatment and lower disease activity than those on therapy with csDMARDs within a period of 12 months of treatment. Current management strategies should focus on switching on another medication earlier in the treatment plan when patients inadequately respond to therapy after 6 months of follow up. <h3>Disclosure of Interests</h3> None declared