POS0470 GLUCOCORTICOID DISCONTINUATION IN EARLY RHEUMATOID AND UNDIFFERENTIATED ARTHRITIS PATIENTS. A SUB-ANALYSIS OF THE BeSt AND IMPROVED STUDIES
Authors: J. M. Maassen, R. Dos-Santos, S. A. Bergstra, R. Goekoop, T. Huizinga, C. Allaart
Journal: Annals of the Rheumatic Diseases (2021)

Background: Discontinuation of glucocorticoids (GC) as bridging therapy in rheumatoid arthritis (RA) treatment is recommended as rapidly as clinically feasible. Little is known about the rate of, and possible characteristics associated with successful GC discontinuation. Objectives: To evaluate the success rate of GC discontinuation, and to study which factors are associated with successful GC discontinuation. Methods: Data from two treat-to-target studies; BeSt (target DAS ≤2.4, LDA), and IMPROVED (target DAS &lt;1.6, remission) were evaluated for all patients initially treated with a tapered high-dose of oral GC with conventional DMARD(s). GCs were discontinued when DAS ≤2.4 was maintained for 28 weeks in BeSt, and as soon as DAS was &lt;1.6 in IMPROVED. GC discontinuation could be attempted twice: first attempt called ‘primary’, second attempt after GC restart called ‘secondary’. Discontinuation was considered successful if the treatment target was maintained at the next visit. Univariable, and exploratory forward and backward multivariable logistic regression analyses were performed to identify potential characteristics associated with successful discontinuation (p-value &lt;0.2 included in final model). Results: From the 131 patients initiating combination therapy with prednisone in the BeSt study, 93 attempted discontinuation. Primary discontinuation was successful in 60% (56/93) and secondary discontinuation in 54% (19/35). A lower DAS at the visit prior to GC discontinuation and ACPA negativity were associated with successful discontinuation (table 1). Of the 610 patients in the IMPROVED, 400 attempted discontinuation. Primary discontinuation was successful in 61% (242/400), and secondary in 51% (71/139). A lower DAS both at baseline and at the visit prior to GC discontinuation were associated with successful discontinuation (table 1). Conclusion: Primary GCs discontinuation was successful in approximately 60% and secondary in 50% of patients, independent of the treatment target and associated threshold for GC discontinuation. Most baseline characteristics were not predictive of successful GC discontinuation, but ACPA negativity (only in BeSt), baseline DAS (only in IMPROVED) and in both studies DAS prior to GC discontinuation were predictive for successful discontinuation. Based on this data it seems that ‘standard’ baseline characteristics are insufficient to ‘personalize’ the duration of temporary GC bridging but the DAS at the moment of GC discontinuation might give guidance. Table 1. Results logistic regression analyses Univariable Multivariable a R 2 = 0.173 BeSt OR (95% CI) p-value OR (95% CI) p-value Age, year 1.00 (0.98; 1.03) 0.98 Gender, female 0.51 (0.24; 1.09) 0.08 Symptom duration BL, weeks 1.00 (0.99; 1.01) 0.61 DAS at BL 0.92 (0.61; 1.40) 0.70 DAS prior to discontinuation 0.13 (0.05; 0.33 ) &lt;0.01 0.11 (0.04; 0.30 ) &lt;0.01 RF, positive 1.28 (0.62; 2.69) 0.50 2.24 (0.81; 6,17) 0.12 ACPA, positive 0.70 (0.34; 1.43) 0.32 0.32 (0.12; 0.86 ) 0.02 Erosions, present at BL 0.65 (0.28; 1.49) 0.31 Univariable Multivariable a R 2 = 0.065 IMPROVED OR (95% CI ) p-value OR (95% CI ) p-value Age, year 1.00 (0.99; 1.02) 0.64 Gender, female 0.62 (0.43; 0.89 ) 0.01 0.75 (0.51; 1.11) 0.15 Symptom duration BL, weeks 1.00 (0.99; 1.00) 0.43 0.99 (0.99; 1.00) 0.08 DAS at BL 0.80 (0.65; 0.98 ) 0.03 0.78 (0.62; 0.98 ) 0.03 DAS prior to discontinuation 0.24 (0.15; 0.38 ) &lt;0.01 0.24 (0.14; 0.40 ) &lt;0.01 RF, positive 0.82 (0.57; 1.17) 0.27 ACPA, positive 0.95 (0.66; 1.35) 0.76 Erosions, present at BL 0.80 (0.49; 1.29) 0.35 ACPA: anti-citrullinated protein antibodies; BL: baseline; DAS: disease activity score; RF: rheumatoid factor. α The final multivariable logistic regression model was based on stepwise forward and backward selection of predictors, both resulting in the same final model. Acknowledgements: We would like to thank all patients for their contribution as well as the rheumatologists who participated in the BeSt study group and in the IMPROVED-study group. We would also like to thank all other rheumatologists and trainee rheumatologists who enrolled patients in these studies, and all research nurses for their contributions. Disclosure of Interests: Johanna M. Maassen: None declared, Raquel Dos-Santos: None declared, Sytske Anne Bergstra: None declared, Robbert Goekoop: None declared, Thomas Huizinga: None declared, Cornelia Allaart Grant/research support from: The original BeSt study was realized with a government grant from the Dutch College of Health Insurance Companies, with additional funding from Schering-Plough and Janssen. the IMPROVED study was financially supported by AbbVie in the first year.