OP0219 MORTALITY OF RHEUMATOID ARTHRITIS PATIENTS, TREATED TO TARGET AT LOW DISEASE ACTIVITY: 17-YEARS FOLLOW-UP OF THE BEST COHORT
Authors: J. M. Maassen, Y. Goekoop-Ruiterman, H. Van Groenendael, W. Lems, P. Kerstens, T. Huizinga, C. Allaart
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid arthritis is known to be associated with increased mortality over the years when compared to the general population. In the BeSt study, 508 patients were treated to target (Disease Activity Score ≤2.4) for 10 years between April 2000 and August 2012. At the end of the initial study follow-up, the observed mortality in the BeSt cohort was similar to mortality in the general population. In the current study we evaluated the mortality in the BeSt cohort after 17 years follow-up and compared it to the general Dutch population. Objectives: Evaluate long-term mortality in the BeSt study cohort. Methods: In the BeSt study 508 patients diagnosed with early RA were randomized to four initial treatment strategies: 1. Sequential monotherapy; 2. Step-up combination therapy; 3. Initial combination therapy with prednisone; or 4. Initial combination therapy with infliximab. During the 10-year follow-up period treatment was steered at low disease activity (DAS ≤2.4) and adjusted every three months when necessary. After 10-years patients were treated and followed-up according to regular care. We explored mortality through the Dutch state registry for mortality (Centrum voor Familiegeschiedenis) and treating rheumatologist. Mortality in the BeSt cohort was compared to the general Dutch population (Statistics Netherlands) matched by gender, age and calendar year using the standardized mortality ratio (SMR). Kaplan-Meier curves and the log-rank test were used to compare survival among the initial treatment strategies. Results: The mean duration of follow-up in non-deceased patients was 17 years (range 16-18). In total, 143 patients died (28%) compared to a total of 105 (21%) expected deaths in the reference population. The overall SMR after 17 years was 1.37 (95% CI: 1.16-1.61). Within the study population, no statistically significant difference in survival-curves was observed between the four initial treatment strategies (log-rank p=0.76) (table 1, and figure 1). Table 1. BeSt study cohort mortality - stratified for initial treatment strategy Sequential monotherapy n=126 Step-up combination therapy n=121 Initial combination therapy with prednisone n=133 Initial combination therapy with infliximab n=128 N (%) † 38 (30) 31 (26) 41 (31) 33 (26) SMR (95% CI ) 1.41 (1.03–1.94) 1.20 (0.84-1.70) 1.53 (1.13-2.09) 1.31 (0.93-1.85) SMR: standardized mortality ratio (number observed deaths/number expected deaths); CI: confidence interval.Conclusion: Figure 1. Survival curves – stratified for initial treatment strategy After a mean of 17 years follow-up the mortality was increased in the BeSt study cohort when compared to the general Dutch population. We observed no difference in survival curves among the four treatment strategies. Disclosure of Interests: Johanna M. Maassen: None declared, Yvonne Goekoop-Ruiterman: None declared, Hans van Groenendael: None declared, WIllem Lems Grant/research support from: Pfizer, Consultant of: Lilly, Pfizer, Pit Kerstens: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Cornelia Allaart: None declared