ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2378

Ethnic Minorities with Rheumatoid Arthritis Achieve a Meaningful Clinical Response at 12 Months Despite Infrequent Use of Biologic Therapies

Gail S. Kerr1, Yusuf Yazici2, Christopher Swearingen3, Sharon Dowell4, Luis R. Espinoza5, Edward Treadwell6, Theresa Lawrence-Ford7, Yvonne Sherrer8, Angelia Mosley-WIlliams9, Rodolfo Perez Alamino10, Ignacio Garcia-Valladares11, Akgun Ince12, Mercedes Quinones13, Chunqiao Luo3, Adrian Godoy4 and John Amatruda14, 1Rheumatology, Washington DC VAMC, Georgetown and Howard University, Washington, DC, 2Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, 3Pediatrics and Biostatistics, University of Arkansas, Little Rock, AR, 4Division of Rheumatology, Howard University, Washington, DC, 5Medicine-Section of Rheum, LSU Medical Center, New Orleans, LA, 6Dept Medicine Div of Rheum, E Carolina Univ Sch of Med, Greenville, NC, 7North Georgia Rheumatology Group, PC, Lawrenceville, GA, 8Rheum/Immunology, Centre Rheum Immunol Arthritis, Fort Lauderdale, FL, 9Rheumatology, Detroit VAMC, Detroit, MI, 10internal Medicine, LSUHSC, New Orleans, LA, 11Immunology and Rheumatology, Hospital General de Occidente, Zapopan, Jal., Mexico, 12Arthitis Consultants Inc, St. Louis University, St. Louis, MO, 13Division of Rheumatology, Howard University Hospital, Washington, DC, 14Rheumatology, Howard University, Washington, DC

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Impact of Various Interventions and Therapeutic Approaches

Session Type: Abstract Submissions (ACR)

Ethnic Minorities with Rheumatoid Arthritis Achieve a Meaningful Clinical Response at 12 months Despite Infrequent Use of Biologic Therapies.

Background/Purpose: Ethnic minorities with rheumatoid arthritis (RA) often, for varied reasons, receive less biologic therapies despite more severe disease. Yet, data in this patient subset regarding time to meaningful clinical response and the clinical determinants are lacking. We examined the prevalence of meaningful clinical response (MCR) and its clinical associations in RA ethnic minority patients.

Methods:  Ethnic Minority RA Consortium (EMRAC) patients with at least one follow up visit were evaluated. Comparisons of demographic (age, gender, race, education, smoking), RA disease status (RF, ACPA, nodules/erosions), RA treatment (prednisone, DMARD, biologics) variables amongst ethnic subsets were made as well as frequencies of MCR (DRAPID3 [-3.6]) at 3, 6, and 12 months from enrollment. Baseline differences between ethnic subsets were compared using Chi-square for categorical and Kruskal-Wallis for continuous variables. Logistic regression associating outcome at 3, 6 and 12 months with ethnic subset were estimated adjusting for age, gender, education, disease duration, baseline RAPID3, DMARD and biologic use.

Results:  EMRAC analysis is shown in (Table). African Americans (AA) and Hispanics had fewer years of education, but had longer follow up periods and more frequent clinic visits. Despite higher ACPA and RF titers, frequencies of erosions and baseline RAPID3 scores, both ethnic minority subsets received less biologic but more frequent DMARD therapies. A MCR was more prevalent in AA and Hispanics. While the frequency of a MCR in Hispanics was significant at 3 months (p<0.001) compared to other ethnic subsets, it was similar in AA and Caucasians. However at 6 and 12 months – achievement of a MCR was more frequent in both AA and Hispanic patients.

Conclusion: Despite more severe RA disease and infrequent biologic use, frequent follow up visits in ethnic minority patients result in the achievement of a meaningful clinical response within 6 months of disease management.  The long term outcome of these variations in RA therapies among ethnic subsets, particularly with regards to cardiovascular disease, requires further study.  

 

Table: Clinical Characteristics of EMRAC cohort and Frequencies of Meaningful Clinical (RAPID3) Response

Total

Caucasian

African-American

Hispanic

P

N

 

671

299

225

147

 

# of Followup visits

3.0 (2.7)

2.7 (2.7)

2.9 (2.4)

3.6 (3.0)

<0.001

Followup Length (months)

9.4 (8.2)

7.4 (5.0)

12.2 (11.5)

9.0 (5.6)

<0.001

Age (years)

55.8 (15.4)

54.7 (16.5)

58.0 (14.6)

54.9 (13.9)

0.079

Female (N %)

541 (80.6%)

231 (77.3%)

193 (85.8%)

117 (79.6%)

0.047

Duration (years)

9.6 (9.6)

9.2 (9.7)

10.1 (9.8)

9.1 (9.2)

0.338

Education (years)

14.3 (3.6)

15.6 (3.1)

13.4 (3.3)

12.8 (4.1)

<0.001

RAPID3 [0-30]

11.7 (7.4)

10.5 (7.4)

12.5 (7.0)

12.8 (7.7)

0.004

Hx Smoking (N %)

160 (32.7%)

77 (36.0%)

57 (31.8%)

26 (27.1%)

0.289

RF+ (N %)

277 (50.9%)

72 (31.2%)

147 (73.1%)

58 (51.8%)

<0.001

ACPA+ (N %)

167 (31.6%)

27 (11.7%)

106 (55.8%)

34 (31.2%)

<0.001

ACPA

143.6 (103.8)

83.4 (96.0)

175.3 (92.2)

115.1 (109.8)

<0.001

RF

279.8 (337.3)

247.5 (375.0)

259.8 (294.5)

366.7 (380.2)

0.043

Hx Nodules (N %)

33 (8.0%)

11 (6.1%)

15 (8.9%)

7 (11.3%)

0.374

Hx Erosions (N %)

110 (25.1%)

21 (11.2%)

69 (38.5%)

20 (28.2%)

<0.001

Prednisone (N %)

228 (34.0%)

83 (27.8%)

94 (41.8%)

51 (34.7%)

0.004

DMARD (N %)

474 (70.6%)

195 (65.2%)

181 (80.4%)

98 (66.7%)

<0.001

Biologic (N %)

234 (34.9%)

127 (42.5%)

50 (22.2%)

57 (38.8%)

<0.001

RAPID3 Response D-3.6 Points

3 Months

73 (10.9%)

27 (9.0%)

19 (8.4%)

27 (18.4%)

0.001*

6 Months

127 (18.9%)

46 (15.4%)

48 (21.3%)

33 (22.4%)

0.004*

 

12 Months

164 (24.4%)

60 (20.1%)

59 (26.2%)

45 (30.6%)

0.007*

* Logistic Regression adjusting for Age, Gender, Duration, Education, Baseline RAPID3, DMARD and Biologic Use.

 

Disclosure:

G. S. Kerr,

Genentech and Biogen IDEC Inc.,

2,

Bristol-Myers Squibb,

2,

Pfizer Inc,

2;

Y. Yazici,

Genentech and Biogen IDEC Inc.,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2,

Abbvie,

5,

Bristol-Myers Squibb,

5,

Celgene,

5;

C. Swearingen,

Genentech and Biogen IDEC Inc.,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2;

S. Dowell,

Genentech and Biogen IDEC Inc.,

2,

Pfizer,

2,

Bristol-Myers Squibb,

2;

L. R. Espinoza,

Genentech and Biogen IDEC Inc.,

2,

Pfizer,

2,

Bristol-Myers Squibb,

2;

E. Treadwell,

Genentech,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2;

T. Lawrence-Ford,

Abbvie,

8,

Pfizer Inc,

8,

Horizon ,

8,

Actelion Pharmaceuticals US,

8,

Questcor ,

8,

Takeda,

8,

UCB ,

8;

Y. Sherrer,

Genentech and Biogen IDEC Inc.,

2,

Pfizer,

2,

Bristol-Myers Squibb,

2;

A. Mosley-WIlliams,

Genentech and Biogen IDEC Inc.,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2;

R. Perez Alamino,

Genentech and Biogen IDEC Inc.,

2,

Pfizer,

2,

Bristol-Myers Squibb,

2;

I. Garcia-Valladares,

Genentech and Biogen IDEC Inc.,

2,

Pfizer,

2,

Bristol-Myers Squibb,

2;

A. Ince,

Genentech and Biogen IDEC Inc.,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2;

M. Quinones,

Genentech and Biogen IDEC Inc.,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2;

C. Luo,
None;

A. Godoy,
None;

J. Amatruda,
None.

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