ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 551

Leflunomide As a Concomitant DMARD Choice for the Biological Treatment Era of Rheumatoid Arthritis

Gezmis Kimyon1, Sedat Kiraz2, Ihsan Ertenli2, Orhan Kucuksahin3, Ediz Dalkiliç4, Cemal Bes5, Nilufer Alpay Kanitez6, Timucin Kasifoglu7, Hakan Emmungil8, Belkıs Nihan Coşkun4, Burcu Yagız4, Suleyman Serdar Koca9, Muhammet Cinar10, Aşkın Ateş11, Servet Akar12, Duygu Ersozlu Bakirli13, Veli Yazisiz14, Nazife Sule Yasar Bilge7, Muge Aydin Tufan15, Ridvan Mercan16, Omer Karadag2, Ayse Bahar Kelesoglu11, Onay Gercik17, Burak Oz9, Zeynel Abidin Akar9, Sedat Yılmaz18, Sezin Turan8, Yavuz Pehlivan4, Ender Terzioglu14, Levent Kilic2, Sukran Erten19, Emre Tekgöz10, Koray Tascilar20 and Umut Kalyoncu2, 1Rheumatology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Turkey, 2Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey, 3Rheumatology, Liv Hospital, Ankara, Turkey, 4Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey, 5Department of Rheumatology, Health Sciences University Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey, 6Rheumatology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey, 7Rheumatology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey, 8Rheumatology, Trakya University Faculty of Medicine, Edirne, Turkey, 9Rheumatology, Firat University Faculty of Medicine, Elazığ, Turkey, 10Rheumatology, Gülhane Military Medical Academy, Faculty of Medicine, Ankara, Turkey, 11Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey, 12Department of Internal Medicine, Division of Rheumatology,, Izmir Katip Çelebi University Faculty of Medicine, Izmir, Turkey, 13Department of Rheumatology, Adana Numune Training and Research Hospital, Adana, Turkey, 14Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey, 15Rheumatology, Baskent University Faculty of Medicine, Adana, Turkey, 16Rheumatology, Namik Kemal University Faculty of Medicine, Tekirdağ, Turkey, 17Rheumatology, Izmir Katip Çelebi University Faculty of Medicine, Izmir, Turkey, 18Division of Rheumatology, Gülhane Military Medical Academy, Faculty of Medicine, Ankara, Turkey, 19Rheumatology, Yildirim Beyazit University Faculty Of Medicine, Ankara, Turkey, 20Rheumatology, Okmeydani Research and Training Hospital, Istanbul, Turkey

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Methotrexate and leflunomide are anchor conventional synthetic DMARDs (csDMARDs) for rheumatoid arthritis (RA) treatment. Although methotrexate is the usual recommended concomitant csDMARD along with biological DMARDs (bDMARDs), leflunomide is an alternative treatment option. Objective of this study was to describe leflunomide survival with concomitant bDMARDs use.

Methods: TReasure is a multicenter, web-based registry of RA and spondyloarthritis patients receiving targeted treatments. As of May 2018, 1401 RA patients were recorded. Age, sex, disease duration, BMI, initial bDMARDs, acute phase reactants, swollen and tender joint counts (28 joints), patient global assessment of disease activity, pain VAS, DAS-28, CDAI, and SDAI were recorded before starting bDMARDs. Patients starting a bDMARD were divided into two groups. Group 1 included patients receiving concomitant leflunomide with or without other csDMARDs combined with leflunomide. Group 2 consisted of patients using other concomitant csDMARDs or combinations that did not include leflunomide. DAS-28 disease state at the last recorded visit was compared. Retention rate of leflunomide was calculated by Kaplan-Meier analysis.

Results: Overall, 1401 patients, 444 of which (31.6%) using leflunomide with their first bDMARD were included. Demographic data and baseline disease activity are given in table 1. Initial bDMARDs in group 1 were anti-TNF drugs 275 (61.9%), abatacept 77 (17.3%), rituximab 59 (13.3%), tofacitinib 20 (4.5%), and tocilizumab 13 (2.9%). At the baseline visit leflunomide was combined with hydroxychloroquine [266 (59.9%)], methotrexate [83 (18.7%)], or sulfasalazine [67 (15.1%)]. Median (Q1-Q3) duration of treatment with leflunomide was 28 (7-54) months. DAS-28 activity state at the last visit for group 1 and group 2 were; high in 8.8% vs. 8.5%, moderate in 36.7% vs. 33.3%, low in 20.2% vs. 18.0%, and remission in 34.3% vs. 40.1% respectively (p=0.31). Median (Q1-Q3) DAS-28 score at the last visit was not significantly different between groups [3.05 (2.31-3.96) vs. 2.86 (2.18-3.82), p=0.11]. Five-year survival of bDMARDs with concomitant leflunomide was around 80% (figure 1).

Conclusion:  Leflunomide was one of the major concomitant csDMARDs in our RA biological registry. It was combined with both anti-TNF and other biologics. Retention rate of bDMARDs with concomitant leflunomide was satisfactory and disease activity with leflunomide was not significantly different from that with other synthetic DMARDs.

Disclosure: G. Kimyon, None; S. Kiraz, None; I. Ertenli, None; O. Kucuksahin, None; E. Dalkiliç, None; C. Bes, None; N. Alpay Kanitez, None; T. Kasifoglu, None; H. Emmungil, None; B. N. Coşkun, None; B. Yagız, None; S. S. Koca, None; M. Cinar, None; A. Ateş, None; S. Akar, None; D. Ersozlu Bakirli, None; V. Yazisiz, None; N. S. Yasar Bilge, None; M. Aydin Tufan, None; R. Mercan, None; O. Karadag, None; A. B. Kelesoglu, None; O. Gercik, None; B. Oz, None; Z. A. Akar, None; S. Yılmaz, None; S. Turan, None; Y. Pehlivan, None; E. Terzioglu, None; L. Kilic, None; S. Erten, None; E. Tekgöz, None; K. Tascilar, None; U. Kalyoncu, None.

To cite this abstract in AMA style:

Kimyon G, Kiraz S, Ertenli I, Kucuksahin O, Dalkiliç E, Bes C, Alpay Kanitez N, Kasifoglu T, Emmungil H, Coşkun BN, Yagız B, Koca SS, Cinar M, Ateş A, Akar S, Ersozlu Bakirli D, Yazisiz V, Yasar Bilge NS, Aydin Tufan M, Mercan R, Karadag O, Kelesoglu AB, Gercik O, Oz B, Akar ZA, Yılmaz S, Turan S, Pehlivan Y, Terzioglu E, Kilic L, Erten S, Tekgöz E, Tascilar K, Kalyoncu U. Leflunomide As a Concomitant DMARD Choice for the Biological Treatment Era of Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/leflunomide-as-a-concomitant-dmard-choice-for-the-biological-treatment-era-of-rheumatoid-arthritis/. Accessed .

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