Benefit of Early Therapy with Methotrexate and Prednisone in Patients with Early Rheumatoid Arthritis and Undifferentiated Early Arthritis (CONAART)

Soledad Retamozo¹, Maria Jezabel Haye Salinas², Juan Pablo Pirola³, Diego Baenas², Ana C. Alvarez⁴, Veronica Saurit³, Alejandro Alvarellos⁵, Christian A. Waimann⁶, Gustavo Citera^7,8, Fernando Dal Pra⁹, Celeste Orozco⁹, Federico Ceccato¹⁰, Sergio Paira¹⁰, MV Martire¹¹, G Crespo Amaya¹¹, Anastasia Secco¹¹, M Mamani¹¹, Javier Rosa¹², Enrique Soriano¹², Josefina Marcos¹³, Mercedes Argentina García¹⁴, Carolina Costi¹⁵, María M Zalazar¹⁶, Alejandro Martinez Muñoz¹⁶, Oscar Luis Rillo¹⁷, Horacio Berman¹⁸, Alberto Berman¹⁸, Francisco Colombres¹⁸, Edson Javier Velozo¹⁹, Vicente Ricardo Juarez²⁰, M Crespo²⁰, A Quinteros²¹, M Leal²¹, G Salvatierra²², Monica Sacnún²³, R Quintana²³, M Abdala²⁴ and Francisco Caeiro²⁵, ¹Rheumatology Unit, Hospital Privado Centro Médico de Córdoba, Argentina, Córdoba, Argentina, ²Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, ³Rheumatology, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina, ⁴Hospital Privado Centro Medico de Cordoba, Cordoba, Argentina, ⁵Rheumatology, Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina, ⁶Escuela Superior de Ciencias de la Salud, UNICEN., Olavarria,, Argentina, ⁷Rheumatology, Instituto de Rehabilitacion Psicofisica - Fundacion Reumatologica Argentina Dr. Osvaldo Garcia-Morteo, Buenos Aires, Argentina, ⁸Rheumatology, CONAART - IREP, Buenos Aires, Argentina, ⁹Instituto De Rehabilitación Psicofísica, Argentina, CABA, Argentina, ¹⁰Hospital Dr José María Cullen, Santa Fe, Argentina, ¹¹Hospital Bernardino Rivadavia, CABA, Argentina, ¹²Hospital Italiano De Buenos Aires, CABA, Argentina, ¹³Hospital San Martin, La Plata, Argentina, ¹⁴Rheumatology Unit, HIGA San Martín La Plata, La Plata, Argentina, ¹⁵Hospital San Martín, LaPlata, Argentina, ¹⁶Hospital Pirovano, CABA, Argentina, ¹⁷Rheumatology Department, Hospital General de Agudos “Dr. Ignacio Pirovano”, Buenos Aires, Argentina, Buenos Aires, Argentina, ¹⁸Centro Médico Privado De Reumatología (Tucumán), Tucumán, Argentina, ¹⁹Rheumatology, Sanatorio Adventista del Plata, Entre Rios, Argentina, ²⁰Hospital Señor Del Milagro, Salta, Argentina, ²¹Centro Integral De Reumatología, Tucumán, Argentina, ²²Instituto Provincial De Rehabilitación Integral, Santiago del Estero, Argentina, ²³Hospital Provincial De Rosario, Rosario, Argentina, ²⁴Hospital Provincial Del Centenario, Rosario, Argentina, ²⁵Rheumatology, Hospital Privado Centro Medico De Córdoba, Cordoba, Argentina

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Early Rheumatoid Arthritis, methotrexate (MTX), prednisolone, prednisone and treatment

Session Information

Date: Sunday, November 13, 2016

Title: Epidemiology and Public Health - Poster I

Session Type: ACR Poster Session A

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

Background/Purpose: To analyze clinical remission in patients with early RA and undifferentiated arthritis (UA) during the first 2 years of treatment using methotrexate (MTX) and prednisone.

Methods: Database included patients diagnosed with early RA, less than 2 years of evolution. Patients were divided into 3 groups according to when the treatment was started 0-3 months, >3-6 months or >6 months of onset of symptoms. Descriptive statistics were applied to each of the variables Student’s t-test and the chi-squared test were applied and Fisher’s exact test was used where necessary. Univariate analysis was performed using Mann Whitney test and Multivariate logistic regression models were used to measure the association with remission defined by DAS 28, SAI, CDAI, and ACR/EULAR scores. A value of p ≤ 0.05 was considered significant.

Results: Of 2078 included patients, 442 were available for the intent-to-treat analysis (ITT). 83% were women with mean age 52.74 years (SD 14.05) and a median duration of symptoms of 6.5 months (IQR 3.0–12.0) by the time they entered into the study. Of the total, 303 (68.6%) had RA (ACR 1987) and 139 (31.4%) UA. ESR 35.15 mm/h (IQR15-48.75), CRP 16.77 mg/dl,(IQR 0.5 to 11.51), positive RF in 275 (62.2%) patients. The clinical characteristics at baseline were: HAQ 1.17 (IQR 0.5-1.75), DAS 28 5.14 (SD 1.32), CDAI 25.98 (IQR 15-35), IAS 28.68 (IQR 18.42-38.57), hands SENS 8.34 (IQR 2-13), feet SENS 2.64 (IQR 0-4). During the study, 415 (93.9%) received MTX (average dose 15mg/week) and prednisone (average dose 7.97 mg/day) in 410 (99.8%) patients. MTX and prednisone were initiated with a mean at 8.83 (IQR 3-13) months and 7.55 (IQR 2-12) months, respectively, from the onset of symptoms. The patients who reached remission at some point in 2 years follow-up measured by DAS 28 were in 305 (69%), by IAS in 288 (65.2%), by CDAI in 255 (57.7%) and by ACR/EULAR score in 224 (50.7%) patients. Table 1 and 2 show higher remission percentages in a group of patients were treated with combination therapy with MTX and prednisone, especially in those who the onset of symptoms was before 6 months of evolution of the disease. In multivariate analysis, patients treated with MTX achieved remission at some point the follow up with DAS28 (OR 3.88, 95%CI 1.66-9.06, p=0.002), IAS (OR 2.98, 95%CI 1.50-5.88, p=0.002), CDAI (OR 3.00, 95%CI 1.57-5.72, p=0.001), ACR/EULAR score (OR 2.80, 95%CI 1.49-5.25, p=0.001) and lower HAQ at baseline in those who had less 3 months from the onset of symptoms. Table 1: Remission percentages in patients who received combined treatment with MTX and prednisone. Univariate analysis.

Remission	MTX/Prednisone (NO) n (%)	MTX/Prednisone (YES) n (%)	P
DAS 28 < 2.6	93 (60.0%)	212 (73.9%)	0.004
SAI < 5.5	87 (56.1%)	201 /70.0%)	0.005
CDAI < 2.8	81 (52.3%)	174 (60.6%)	0.11
ACR/EULAR	65 (41.9%)	159 (55.4%)	0.007

Table 2. Remission by the different scores depending on the time of treatment start from the onset of symptoms. Univariate analysis.

Remission	MTX/Prednisone 0-3 months n (%)	MTX/Prednisone >3-6 months n (%)	MTX/Prednisone > 6 months n (%)	P
DAS 28 < 2.6	87 (73.7%)	70 (76.8%)	128 (63.7%)	0.04
SAI < 5.5	87 (73.7)	67 (70.5%)	121 (60.2%)	0.03
CDAI < 2.8	82 (68.9%)	60 (63.2%)	100 (49.8)	0.02
ACR/EULAR	74 (62.2%)	56 (58.9%)	85 (42.3%)	0.01

Conclusion: Early treatment with MTX and prednisone is associated with greater opportunities to reach remission.

Disclosure: S. Retamozo, None; M. J. Haye Salinas, None; J. P. Pirola, None; D. Baenas, None; A. C. Alvarez, None; V. Saurit, None; A. Alvarellos, None; C. A. Waimann, None; G. Citera, None; F. Dal Pra, None; C. Orozco, None; F. Ceccato, None; S. Paira, None; M. Martire, None; G. Crespo Amaya, None; A. Secco, None; M. Mamani, None; J. Rosa, None; E. Soriano, None; J. Marcos, None; M. A. García, None; C. Costi, None; M. M. Zalazar, None; A. Martinez Muñoz, None; O. L. Rillo, None; H. Berman, None; A. Berman, None; F. Colombres, None; E. J. Velozo, None; V. R. Juarez, None; M. Crespo, None; A. Quinteros, None; M. Leal, None; G. Salvatierra, None; M. Sacnún, None; R. Quintana, None; M. Abdala, None; F. Caeiro, None.

To cite this abstract in AMA style:

Retamozo S, Haye Salinas MJ, Pirola JP, Baenas D, Alvarez AC, Saurit V, Alvarellos A, Waimann CA, Citera G, Dal Pra F, Orozco C, Ceccato F, Paira S, Martire M, Crespo Amaya G, Secco A, Mamani M, Rosa J, Soriano E, Marcos J, García MA, Costi C, Zalazar MM, Martinez Muñoz A, Rillo OL, Berman H, Berman A, Colombres F, Velozo EJ, Juarez VR, Crespo M, Quinteros A, Leal M, Salvatierra G, Sacnún M, Quintana R, Abdala M, Caeiro F. Benefit of Early Therapy with Methotrexate and Prednisone in Patients with Early Rheumatoid Arthritis and Undifferentiated Early Arthritis (CONAART) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/benefit-of-early-therapy-with-methotrexate-and-prednisone-in-patients-with-early-rheumatoid-arthritis-and-undifferentiated-early-arthritis-conaart/. Accessed .

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