Background/Purpose: Distinct subgroups of RA are being identified by clinical, biochemical, and genomic markers. ACPA positivity is one such biomarker associated with a clinical profile of early rapidly progressing RA. This study aimed to understand the distribution of anti-cyclic citrullinated peptide (anti-CCP2) concentration and its impact on treatment patterns among RA patients in the real-world community practice setting.

Methods: A retrospective cohort study using chart review methodology was used to abstract data of adult RA patients treated in US community rheumatology clinics with biologic disease modifying antirheumatic drug (bDMARD) within 1 year of data collection launch (April 2019). Rheumatologists provided patient-level data from medical records including demographics, biomarkers, treatment sequencing, and clinical outcomes. Patient characteristics and outcomes were summarized descriptively.

Results: The majority (77.6%; n=706) of 910 RA patients meeting eligibility were tested for ACPA at the time of RA diagnosis. Among the 75.9% (n=536) who were ACPA positive (anti-CCP2 >19 AU/mL), the anti-CCP2 quartiles observed were: 20-64 AU/mL, 65-142 AU/mL, 143-246 AU/mL, and 250-19,000 AU/mL. Gender distribution was similar (70%-75% female) across anti-CCP2 quartiles, while median ages were: 45.5, 42.0, 53.0, and 48.0 years, across increasing quartiles. The proportion of patients with rheumatoid factor positivity increased with each anti-CCP2 quartile (79.8%, 90.5%, 91.1%, and 93.1%, respectively). Prior bDMARD use was: 34.6%, 29.5%, 36.7%, and 40.5% in quartiles 1-4, respectively. Among the experienced bDMARD users, higher proportions of patients had ≥2 prior bDMARD use in higher quartiles (25.0%, 19.4%, 34.5%, and 32.1%, respectively). Current bDMARD use was similar across quartiles of anti-CCP2; 25.2% with ACPA positivity were treated with adalimumab, followed by 19.8% etanercept, 17.4% abatacept, 10.4% certolizumab, 10.4% tocilizumab, 6.5% infliximab, 5.4% golimumab, and 4.9% rituximab.

Conclusion: Results of this real-world evidence research demonstrate that while ACPA testing has achieved good adoption in US community rheumatology practice, anti-CCP titers do not appear to be correlated with bDMARD selection. Further research of the prognostic value of ACPA-positivity/titers may further aid in the clinical identification of the most appropriate bDMARD for each patient.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-distribution-of-anti-cyclic-citrullinated-peptide-concentrations-and-impact-on-treatment-patterns-of-patients-with-rheumatoid-arthritis/