Session Information
Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity
Session Type: Abstract Submissions (ACR)
Double Positivity of RA Serologies More Prevalent But Associated with Clinical Response in a Diverse Ethnic Cohort with Rheumatoid Arthritis
Background/Purpose: The presence of both the anti-citrullinated peptide antibody (ACPA) and a rheumatoid factor (RF) are associated with RA disease severity and portend a poor prognosis. Whether ethnic minorities differ in the prevalence of RA-related serologies from Caucasian RA counterparts is unknown, as is their role as determinants of a clinical response in this patient subset.
Methods: Ethnic Minority RA Consortium (EMRAC) patients with at least one follow up visit were evaluated. Comparisons of demographic (age, gender, race, education, smoking), RA disease status (RF, ACPA, nodules/erosions), RA treatment (prednisone, DMARD, biologics) variables amongst ethnic subsets were made as well as frequencies of clinical response (D MDHAQ – 0.3 and D RAPID3 -3.6) from baseline. Baseline differences between ethnic subsets were compared using Chi-square for categorical and Kruskal-Wallis for continuous variables. Logistic regression associating outcome at follow up and between ethnic subsets were estimated, adjusting for age, smoking, race, education, baseline RAPID3, and double positivity of RA-related serologies.
Results: Follow up visits in 671 EMRAC patients provided data for analyses (Table). African American patients were older (p=0.02), and had longer follow up compared to either Caucasians or Hispanics (p< 0.001). Either a positive ACPA (60%, 46.3% vs 14.3%, respectively, p<0.001) or RF (79.6%, 71.7%, respectively vs 42.1%, p<0.001) were more frequent in AA and Hispanics versus Caucasian patients. In patients who were double positive, the odds ratio for a clinical response was 2.7 (95% CI 1.37, 5.35) for MDHAQ and 3 fold (95% CI 1.37, 6.76) for RAPID3. There was a greater frequency of both ACPA+/RF+ in ethnic subsets who had a clinical response in both MDHAQ (AA 57.9%, Hispanics 46.9% vs Caucasian 16.7%) and RAPID3 (AA 64.9%, Hispanic 55% vs Caucasian 17.9%). Hispanic patients with RF+/CCP+ had a 67% increased odds of a RAPID response compared to Caucasians and 8% to AA, while AA had a 55% increase in odds for clinical response compared to Caucasians – but none achieving statistical significance.
Conclusion: In a diverse cohort, double positivity of RA-related serologies while more prevalent, are associated with increased odds of a clinical response regardless of ethnicity
|
RAPID3 Outcomes by Race and Double Positive RA Serology Status |
|||
|
HAQ Response |
|||
|
Caucasian |
African-American |
Hispanic |
|
|
RF-ACPA- |
40(66.7%) |
15(15.8%) |
11(34.4%) |
|
RF+ACPA- |
10(16.7%) |
20(21.1%) |
5(15.6%) |
|
RF-ACPA+ |
0(0%) |
5(5.3%) |
1(3.1%) |
|
RF+ACPA+ |
10(16.7%) |
55(57.9%) |
15(46.9%) |
|
RAPID Response |
|||
|
RF-ACPA- |
27(69.2%) |
11(19.3%) |
6(30%) |
|
RF+ACPA- |
4(10.3%) |
6(10.5%) |
3(15%) |
|
RF-ACPA+ |
1(2.6%) |
3(5.3%) |
0(0%) |
|
RF+ACPA+ |
7(17.9%) |
37(64.9%) |
11(55%) |
Disclosure:
M. Quinones,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2;
S. Dowell,
Genentech and Biogen IDEC Inc.,
2,
Pfizer,
2,
Bristol-Myers Squibb,
2;
I. Garcia-Valladares,
Genentech and Biogen IDEC Inc.,
2,
Pfizer,
2,
Bristol-Myers Squibb,
2;
G. S. Kerr,
Genentech and Biogen IDEC Inc.,
2,
Bristol-Myers Squibb,
2,
Pfizer Inc,
2;
C. Swearingen,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2;
L. R. Espinoza,
Genentech and Biogen IDEC Inc.,
2,
Pfizer,
2,
Bristol-Myers Squibb,
2;
Y. Yazici,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2,
Abbvie,
5,
Bristol-Myers Squibb,
5,
Celgene,
5;
E. L. Treadwell,
Genentech and Biogen IDEC Inc.,
2,
Pfizer,
2,
Bristol-Myers Squibb,
2;
T. Lawrence Ford,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2,
Human Genome Sciences, Inc.,
2,
Abbive,
2,
Eli Lilly and Company,
2,
Roche Pharmaceuticals,
2,
Bristol-Myers Squibb,
9,
Questcor,
8,
Abbvie,
8,
UCB,
8,
Pfizer Inc,
8,
Amgen,
8,
Takeda,
8,
Actelion Pharmaceuticals US,
8;
Y. Sherrer,
Genentech,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2;
A. Mosley-WIlliams,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2;
R. Perez Alamino,
Genentech and Biogen IDEC Inc.,
2,
Pfizer,
2,
Bristol-Myers Squibb,
2;
C. Luo,
None;
A. Ince,
Genentech and Biogen IDEC Inc.,
2,
Pfizer Inc,
2,
Bristol-Myers Squibb,
2;
A. Godoy,
None;
J. Amatruda,
None.
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