Session Information
Date: Tuesday, November 15, 2016
Session Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Rheumatoid arthritis (RA) can be divided into two major subsets based on the presence or absence of antibodies to citrullinated peptide antigens (ACPA). Some studies have indicated that RA patients who are positive for ACPA have a worse prognosis than ACPA negative patients and may require a more aggressive therapeutic approach to control disease. The purpose of this review was to determine if the presence or absence of ACPA antibodies is associated with a more active disease and if patients were more likely to be placed on biologics based on their ACPA status.
Methods: The de-identified data of RA patients were reviewed. Patients were seen in one academic center between 2008 and 2016. ACPA+ status was determined by at least one anti-CCP titer >20 units, using the QUANTA Lite CCP3.1 IgG/IgA ELISA testing. RF positive status was determined by a titer >14 units using turbidometry. RF data was available in 97% of ACPA positive patients and 96% of ACPA negative patients. RA patients with interstitial lung disease (N=130) were excluded. Self-reported disease activity was available for 43% ACPA+ and 35% of ACPA- patients using the Multidimensional Health Activity Questionnaire (MDHAQ) and RAPID 3 instruments on at least one visit. Fisher’s Exact Test was used to determine differences in drug utilization between ACPA positive and negative RA patients. A Bonferroni-adjusted P <0.05 was considered statistically significant.
Results: The demographics of the study group (N=1070) are listed in Table 1. The characteristics of the patients in the two groups were quite similar. Disease severity was similar between the two groups as measured by RAPID 3 (11.2 and 11.9) or by MDHAQ (0.72 and 0.71). As expected, ACPA+ patients were also more likely to be RF+ (84%) than ACPA- patients (64%). The medications used to treat these patients are depicted in figure 1 showing that a higher percentage of ACPA+ patients used MTX and prednisone. Except for a slightly higher number of ACPA+ patients receiving abatacept, ACPA- and ACPA+ patients had similar use of biologics.
Conclusion: This retrospective study shows that ACPA+ and ACPA- RA patients had similar demographic characteristics and similar level of disease severity in our institution. The use of MTX and prednisone was higher among ACPA+ patients; however ACPA- patients had similar use of biologics, except for a slightly lower use of abatacept.
| Table 1: Patient demographics and disease severity stratified by ACPA status | |||||
| Results: Demographics |
CCP+ |
CCP- |
|||
|
Total |
|
647 |
60% |
438 |
40% |
|
Gender |
Female |
479 |
74% |
340 |
78% |
|
Male |
168 |
26% |
98 |
22% |
|
|
Age |
> 65 |
192 |
30% |
131 |
31% |
|
40 – 65 |
347 |
55% |
233 |
55% |
|
|
< 40 |
91 |
14% |
56 |
13% |
|
|
BMI |
> 25 |
484 |
63% |
317 |
62% |
|
<= 25 |
281 |
37% |
191 |
38% |
|
|
Smoking |
Never |
316 |
50% |
234 |
55% |
|
Current |
101 |
16% |
41 |
10% |
|
|
Prior |
217 |
34% |
151 |
35% |
|
|
Rheumatoid Factor |
Positive (>=14) |
530 |
84% |
195 |
46% |
|
Disease Activity |
MDHAQ |
0.72 |
0.71 |
||
|
RAPID3 |
11.2 |
11.9 |
|||
To cite this abstract in AMA style:
Meehan R, Hoffman E, Muram D, Goldstein B, Crooks J, Zelarney P. DMARD, Biologic and Small Molecule Drug Use Among ACPA Positive and ACPA Negative RA Patients in a Tertiary Referral Center [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/dmard-biologic-and-small-molecule-drug-use-among-acpa-positive-and-acpa-negative-ra-patients-in-a-tertiary-referral-center/. Accessed January 15, 2021.« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/dmard-biologic-and-small-molecule-drug-use-among-acpa-positive-and-acpa-negative-ra-patients-in-a-tertiary-referral-center/