Background/Purpose: Since the year 2016 Rheumatoid Arthritis (RA) patients in the Chilean public health system can access biologic treatment if they have active disease refractory to non biologic DMARDs (see inclusion criteria). At first only Abatacept was available as first line biologic. The first patients that initiated biologic treatment in our center were those who had a long lasting active disease. Our main objective was to evaluate the response to treatment with Abatacept in the patients from our center.

Methods: RA patients (ACR 2010 criteria), 18 years old or older, that had a DAS28 ESR > 5.1 in two different occasions separated by at least one month despite the use of at least 3 DMARDs, including methotrexate or leflunomide, for at least 6 monts, were included. Patients with any contraindication to use Abatacept were excluded. Information about work status, gender, age, years since diagnosis, comorbidities, and medications used was collected. The patients were followed for 6 months and the DAS28 ESR was measured at baseline and end of follow-up, and the EULAR response criteria was calculated. Changes from baseline to end of follow-up were analyzed using T-test for paired variables or Wilcoxon signed-rank sum test, and associations between variables were assessed using T-test, Mann-Whitney U test and Chi-Squared test or Fisher’s exact test, as appropiate

Results: 44 patients were included. Baseline characteristics are described in table 1. Of note, 37.2% had a disability pension and the median years with disease were 13 (IQR 7-17). The improvement of DAS28 ESR and its variables was statistically significant (table 2). According to the EULAR response criteria 22.7% of the patients achieved a good response, 52.3% achieved a moderate response and 25% had no response to treatment with Abatacept. 4 of the 10 patients with good response achieved remision (DAS28 ESR <2.6). Gender, age, years since diagnosis, use of Metothrexate or other DMARDs, prenisone or NSAIDs use, comorbidities, tobacco use and basal DAS28 ESR did not influence the response to treatment. No adverse events were reported.

Conclusion: In our group of patients, with prolonged disease refractory to treatment with at least 3 DMARDs, 75% achieved at least a moderate response according to the EULAR response criteria whitout adverse events, but less than one quarter achieved a good response. This probably reflects that in these patients the window of opportunity to initiate a suitable treatment to achieve remission was lost. We believe that it is necessary to allow the inclusion of patients with lower DAS28 among the possible beneficiaries of biological therapy in the public health system of our country.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/abatacept-initiation-in-chilean-patients-with-long-lasting-rheumatoid-arthritis-hospital-padre-hurtado-experience/