AB0558 REMISSION, SUSTAINED REMISSION, AND REASONS FOR LOSS OF REMISSION ACCORDING TO DIFFERENT SETS OF CRITERIA IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
Authors: S. Bugatti, L. De Stefano, B. D ’onofrio, E. Cassione Bozzalla, A. Manzo, C. Montecucco
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In patients with rheumatoid arthritis (RA), sustained remission improves physical function, virtually arrests radiographic progression, and reduces mortality. Several definitions of disease remission have been proposed and validated in randomised controlled trials, but their applicability in clinical practice remains poorly explored. <h3>Objectives:</h3> To analyse the frequency of achievement of disease remission and sustained remission, and the drivers of loss of remission according to different definitions in patients with early RA treated with conventional synthetic DMARDs. <h3>Methods:</h3> Data were retrieved from a prospective monocentric cohort of patients with early RA (&lt;12 months of symptoms at inclusion) treated with methotrexate (82% of the cases) (±low dose glucocorticoids) with the target of low disease activity. Patients were evaluated for the achievement of different definitions of remission after 6 months of treatment: SDAI (≤3.3), Boolean2.0 (SJC28, TJC28, CRP all ≤1; PGA ≤2), Boolean1.0 (SJC28, TJC28, CRP and PGA all ≤1). Maintainance of remission according to each set of criteria was evaluated after 6 and 12 months, and reasons for remission loss were classified into inflammatory (increase in SJC28 and/or CRP) or subjective (isolated increase in PGA and/or TJC28). <h3>Results:</h3> Of a total cohort of 816 patients newly diagnosed with RA, 751 (92%) had at least 6 months of follow-up, 712 (87.3%) 12 months, and 656 (80.4%) 24 months. Collectively, after 6 months, SDAI, Boolean2.0 and Boolean1.0 remission were achieved by 21%, 19.2% and 14.4% of the patients, respectively. Among patients in SDAI remission at T6, remission was maintained in 68.3% of the cases for 6 months, and in 49.6% for 12 months. The corresponding rates of 6-months and 12-months sustained remission were 52.6% and 35.8% for Boolean2.0, and 47.6% and 29.1% for Boolean1.0, without significant differences between the two (<b>Figure 1A</b>). Despite comparable proportions of disease relapses, the variables leading to loss of the remission status varied between Boolean2.0 and Boolean1.0 remission. In Boolean2.0, nearly 80% of the patients failed to maintain remission because of an increase of SJC28 and/or CRP &gt;1. In contrast, in Boolean1.0, an isolated increase of the PGA &gt;1 was responsible for 37% of remission losses (<b>Figure 1B</b>). As a result, 55.3% of the patients in Boolean1.0 remission after 6 months were able to maintain 3vBoolean remission (SJC28, TJC28 and CRP all ≤1) in the following 12 months, compared with 35.8% of the patients who reached Boolean2.0 at T6 (p=0.004). <h3>Conclusion:</h3> In the early stages of RA, the risk of relapse after achieving Boolean2.0 point remission is high and mostly driven by inflammatory flares. In contrast, stringent remission according to the original Boolean1.0 definition leads to more prolonged suppression of inflammation, at the expense of a significant number of subjective flares. The advantages and limitations of different sets of criteria in clinical practice need to be further analysed. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Serena Bugatti Pfizer, Ludovico De Stefano: None declared, Bernardo D'Onofrio: None declared, Emanuele Cassione Bozzalla: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Galapagos.