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Abstract Number: 2496

DMARD, Biologic and Small Molecule Drug Use Among ACPA Positive and ACPA Negative RA Patients in a Tertiary Referral Center

Richard Meehan1, Eric Hoffman2, David Muram3, Barbara Goldstein4, Jim Crooks5 and Pearlanne Zelarney6, 1MEDICINE, National Jewish Health, Denver, CO, 2Medicine/Rheumjatology, National Jewish Health, denver, CO, 3Eli Lilly and Company, Indianapolis, IN, 4Rheumatology, National Jewish Health, Denver, CO, 5Biostatistics, National Jewish Health, Denver, CO, 6Bioinformatics, National Jewish Health, Denver, CO

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ACPA, Biomarkers, drug treatment, registry and rheumatoid arthritis (RA)

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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


Disclosure: R. Meehan, Eli Lilly and Company, 2; E. Hoffman, Eli Lilly and Company, 2; D. Muram, Eli Lilly and Company, 1,Eli Lilly and Company, 3; B. Goldstein, None; J. Crooks, None; P. Zelarney, Eli Lilly and Company, 2.

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 July 1, 2022.
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