SAT0042 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING REMISSION AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS
Authors: B. Laurent, S. Giuliani, H. Mezghani, I. Duprat-Lomon, A. Luc, M. De Carvalho Bittencourt, C. Baumann, I. Chary Valckenaere, D. Loeuille
Journal: Annals of the Rheumatic Diseases (2020)

Background: RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment. Objectives: To investigate the value of biological and imaging biomarkers on predicting DAS 28 remission at 6 months, in RA patients initiating IV bDMARD. Methods: From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence. On 173 patients eligible to the study, 4 were lost to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data, were collected when available at treatment initiation. US examination was performed on 12 targeted joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Remission was defined by a DAS 28 &lt; 2.6 at 6 months. Only variables with a p&lt;0.2 in univariate analysis were included in the multivariate model. Table 1. Characteristics of the patients (n=155) at baseline Table 2. Variables predictive of a DAS 28 remission at 6 months for IV bDMARDs Biomarkers Univariate Analysis Bivariate Logistic regression Analysis DAS 28 remission (n= 33 ) No Remission (n=122 ) p value OR (CI95% ) Clinical data Nb of sequence &gt;1 19 (57.6%) 92 (75.4%) 0.052 0.4 (0.2-1.0) Radiography (n=110) Erosive RA 22 (88.0%) 61 (71.8%) 0.118 0.3 (0.1-1.3) US (n=127) Erosive RA 28 (96.6%) 82 (83.7%) 0.117 0.2 (0.0-1.4) Nb B mode synovitis 7.7 (4.5) 5.5 (3.9) 0.013 0.9 (0.8-1.0) Nb PD+ synovitis 6.5 (5.0) 4.3 (3.3) 0.031 0.9 (0.8-1.0) All qualitative variables with a p value &lt;0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available were incorporated in the multivariate logistic regression analysis (n=103/155). In multivariate analysis only the number of B mode synovitis was still significant with OR =1.1 (CI 95%: 1.0-1.3) (p&lt;0,019). Results: On 155 RA patients, 11 had a disease duration &lt; 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)). Conclusion: In RA patients treated by IV bDMARDs, number of PD+ synovitis on ultrasonography was the only predictive biomarker of DAS 28 remission. Disclosure of Interests: Benjamin Laurent Grant/research support from: BMS, Stephane Giuliani Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared