Disease Activity Measures at Baseline and 3 Months as Predictors of Rapid Radiographic Progression in Methotrexate Naïve Patients with Early Rheumatoid Arthritis

Mohammad Movahedi ¹, Deborah Weber ¹, Pooneh Akhavan ² and Edward Keystone³, ¹Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada, ²Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada, ³Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Disease Activity, Early Rheumatoid Arthritis and Rapid Radiograhic Progression, M-DAS, Rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 10, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster I: Risk Factors, Predictors, & Prognosis

Session Type: Poster Session (Sunday)

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

Background/Purpose: Progressive rheumatoid arthritis (RA) is responsible for disabilities in this patient population, characterized by radiographic joint damage. Achieving low disease activity (LDA) in RA is associated with reduction in radiographic progression. We aimed to compare different measures of disease activity and patient reported outcomes including disease activity score (DAS), C-reactive protein (CRP), modified (M) DAS28 (CRP), clinical disease activity index (CDAI), DAS28(CRP) change ≥1.2, and health assessment questionnaire disability index (HAQ-DI) to predict rapid radiographic progression (RPP) in early RA patients.

Methods: Data from the PREMIER study, a 2-year, multicenter, double-blind active comparator–controlled study with methotrexate (MTX) naïve RA patients with active disease of < 3 years, were used. For this analysis, only patients in the MTX arm were analyzed. RRP was defined as change in modified total Sharp (mTSS) > 3.5 at month 12. Logistic regression analysis was used to assess impact of disease activity measures at baseline and 3 months to predict RRP at 12 months. The area under the receiver operating characteristic curve (ROC AUC) was also calculated.

Results: A total of 149 MTX treated patients were included in this analysis with the majority being female (n=113; 75.8%), positive RF (n=127; 85.2%), mean (SD) baseline age 52.9 (13.3) years, disease duration 0.8 (0.9) year, DAS28(CRP) 6.3 (0.9). After adjusting for potential confounders, only M-DAS28(CRP) at baseline (_adjOR=3.29; 95% CI: 1.70-6.36) and 3 months (_adjOR=2.56; 95% CI: 1.43-4.56) strongly predicted RRP at 12 months. Analysis of ROC curves also showed that compared with other measures, M-DAS28(CRP) at baseline and 3 months had highest predictive values (AUC: 0.66 and 0.74 respectively). We found the value of MDAS28(CRP) 4.5 and 2.6 at baseline and 3 months, respectively as optimal cut-off points to maximize sensitivity and specificity for prediction of RRP at 12 months.

Conclusion: M-DAS28(CRP) is a stronger predictor at baseline and 3 months for rapid radiographic progression compared with other disease activity measures and patient reported outcomes in early RA patients initiating MTX.

Disclosure: M. Movahedi, None; D. Weber, None; P. Akhavan, None; E. Keystone, Abbvie, 2, 5, 8, Amgen, 2, 5, 8, AstraZeneca, 5, Astra-Zeneca, 5, Biotest, 5, BMS, 2, 5, 8, Celltrion, 5, Crescendo, 5, Crescendo Bioscience, 5, F. Hoffmann-La Roche Inc, 2, 5, 8, Genentech, 5, Genentech Inc., 5, Genzyme, 5, Gilead, 2, 5, Gilead Sciences, Inc., 5, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Merck, 5, 8, Pfizer, 2, 5, 8, Pfizer Pharmaceuticals, 2, 5, 8, Roche, 2, 5, 8, Sandoz, 5, Sanofi, 2, 5, 8, Sanofi-Aventis, 2, 8, UCB, 5, 8.

To cite this abstract in AMA style:

Movahedi M, Weber D, Akhavan P, Keystone E. Disease Activity Measures at Baseline and 3 Months as Predictors of Rapid Radiographic Progression in Methotrexate Naïve Patients with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/disease-activity-measures-at-baseline-and-3-months-as-predictors-of-rapid-radiographic-progression-in-methotrexate-naive-patients-with-early-rheumatoid-arthritis/. Accessed .

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