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Abstract Number: 2500

Association between Anti-Citrullinated Protein Antibody Status, Erosive Disease and Healthcare Resource Utilization in Patients with RA

Leslie R Harrold1, Lin Guo2, Sean E. Connolly3, Evo Alemao3, Sabrina Rebello4, Ying Shan4 and Joel Kremer5, 1University of Massachusetts Medical School, Worcester, MA, 2Corrona, LLC, Waltham, MA, 3Bristol-Myers Squibb, Princeton, NJ, 4Corrona, LLC, Southborough, MA, 5Albany Medical College and The Center for Rheumatology, Albany, NY

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

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

Background/Purpose: Anti-citrullinated protein antibody (ACPA) is a highly specific biomarker for RA1 and ACPA-seropositive patients have a tendency toward severe erosive disease and more rapid disease progression.2–4 Little is known regarding the impact of poor prognostic factors, such as ACPA and erosive disease, on healthcare resource utilization (HCRU). The purpose of this analysis was to characterize the rate of HCRU between anti-cyclic citrullinated peptide (anti-CCP; a surrogate of ACPA) positive (+) patients with or without erosions who initiated biologic (b)DMARD treatment.

Methods: This analysis included patients aged ≥18 years who were enrolled in a large sequential RA registry (October 2001–August 2017) and who had known erosions, as measured by radiography, and anti-CCP+ status at or prior to bDMARD initiation visit and a 12-month (±3 months) follow-up visit. Anti-CCP+ was defined as ≥20 U/mL. Rates of HCRU, including all-cause hospitalizations, all joint surgeries (total and partial; all sites), radiographic procedures and use of assistive devices, were estimated over 12 months of follow-up from the bDMARD initiation visit in anti-CCP+ patients with or without erosions. Rates of HCRU per 100 patient-years and risk ratios, adjusted by baseline age, were estimated with 95% CI using a Poisson regression model.

Results: A total of 2047 anti-CCP+ patients were included in this analysis, 868 with and 1179 without erosions. At biologic initiation visit, mean (SD) age was 58.9 (12.5) and 55.9 (12.5) years and disease duration was 11.7 (10.1) and 6.4 (7.5) years, respectively, in anti-CCP+ patients with and without erosions. Over 12 months of follow-up, the rates of HCRU were higher among anti-CCP+ patients with versus without erosions at baseline bDMARD initiation visit (Table).

Conclusion: ACPA seropositivity with erosive disease predicts high utilization of healthcare resources, suggesting that early therapeutic intervention may be warranted in anti-CCP+ patients to achieve better disease control and reduce complications from RA.

References:

  1. Scott DL, et al. Lancet 2010;376:1094–108.
  2. van der Helm-van Mil AH, et al. Arthritis Res Ther 2005;7:R949–58.
  3. Hecht C, et al. Ann Rheum Dis 2015;74:2151–6.
  4. Harrold LH, et al. Arthritis Rheumatol 2017:69(S10):499.

Original abstract © EULAR/BMJ. First presented at EULAR 2018 and published in Ann Rheum Dis;doi: 10.1136/annrheumdis-2018-eular.1582. Any reprints, promotional options, education material etc have to be done through the original source (ARD/BMJ).

Table. Age-Adjusted Rates (95% CI) of HCRU and Adjusted Risk Ratios in Anti-CCP+ Patients With RA With and Without Erosions

Age-adjusted rate (95% CI)*†

Adjusted risk ratio (95% CI)*†

Anti-CCP+ without erosions (n=1179)

Anti-CCP+ with erosions (n=868)

Anti-CCP+ with erosions vs anti-CCP+ without erosions‡

Hospitalization, all cause

9.44 (7.77, 11.37)

15.21 (12.72, 18.05)

1.47 (1.14, 1.90)

Joint surgery visits, all sites

3.74 (2.72, 5.02)

5.34 (3.91, 7.12)

1.31 (0.86, 1.98)

Radiography, all cause

18.12 (15.77, 20.72)

22.18 (19.14, 25.56)

1.25 (1.03, 1.53)

Assistive devices

60.65 (56.28, 65.27)

73.03 (67.44, 78.97)

1.12 (1.00, 1.25)

*Rates per 100 patient-years with 95% CI based on Poisson distributed counts

†Adjusted for baseline age

‡Reference group: anti-CCP+ and erosions

Anti-CCP+=anti-cyclic citrullinated peptide positive; HCRU=healthcare resource utilization

Disclosure: L. R. Harrold, Corrona, LLC, 1,Pfizer, Inc., 2,Roche, Bristol-Myers Squibb, 5,Corrona, LLC, University of Massachusetts Medical School, 3; L. Guo, None; S. E. Connolly, Bristol-Myers Squibb, 1, 3; E. Alemao, Bristol-Myers Squibb, 1, 3; S. Rebello, Corrona, LLC, 3; Y. Shan, Corrona, LLC, 3; J. Kremer, Corrona, LLC, 1, 3,AbbVie, Bristol-Myers Squibb, Genentech, Lilly, Novartis, Pfizer, 2,Genentech, Inc., 8.

To cite this abstract in AMA style:

Harrold LR, Guo L, Connolly SE, Alemao E, Rebello S, Shan Y, Kremer J. Association between Anti-Citrullinated Protein Antibody Status, Erosive Disease and Healthcare Resource Utilization in Patients with RA [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/association-between-anti-citrullinated-protein-antibody-status-erosive-disease-and-healthcare-resource-utilization-in-patients-with-ra/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-anti-citrullinated-protein-antibody-status-erosive-disease-and-healthcare-resource-utilization-in-patients-with-ra/