Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: After the introduction of Biological Disease-Modifying Anti-Rheumatic-Drugs (bDMARDs) for the treatment of patients with active rheumatoid arthritis (RA), clinical remission has become an achievable and realistic therapeutic goal. In clinical trials, remission rates in patients receiving bDMARDs are assessed under a fixed-dose regimen of steroid and/or methotrexate (MTX). However, in daily practice, the dose of concomitant MTX and/or steroid is often titrated according to the patient’s response to therapy; thus, remission rates might be influenced by this titration.
To examine usage situation of concomitant MTX and steroid use and remission rate in RA patients receiving bDMARDs in daily practice.
Methods: We have established a large observational cohort of RA patients, IORRA (Institute of Rheumatology, Rheumatoid Arthritis), in our institute since October 2000. Essentially all RA patients who attend our clinic are asked to complete questionnaires every 6 months. Clinical information, including physician’s evaluations and laboratory data, is collected biannually (April and October). As a result, more than 5000 RA patients were registered. All RA patients who commenced treatment with bDMARDs from 2012 to 2016 were extracted from the IORRA database. The 28-joint Disease Activity Score (DAS28), remission rate based on the ACR/EULAR remission criteria, and frequencies of use and doses of MTX and steroid before treatment and 2 years after initiation of each bDMARDs were calculated.
Results: Average DAS28 before and 2 years after the initiation of infliximab (IFX: n=39), etanercept (ETN: n=199), adalimumab (ADA: n=101), tocilizumab (TCZ: n=261), abatacept (ABT: n=123), golimumab (GLM: n=128) and certolizumab pegol (CZP: n=87) were 3.5/2.7, 3.4/2.7, 3.5/2.8, 3.8/2.4, 3.8/3.3, 3.7/2.8, and 3.6/2.9, respectively. The DAS28 remission rates were 56.4%, 57.3%, 53.3%, 64.0%, 23.6%, 50.1%, and 46.0%, respectively. The proportion of patients taking MTX decreased among ETN (78.4% to 59.3%) and TCZ (73.2% to 61.3%)users, while that and MTX dose increased among IFX (79.5% [9.0mg/week] to 84.6% [11.1mg/week]) and ADA (78.7% [9.8mg/week] to 85.3% [12.2mg/week]) users. The frequencies of use and average dose of steroid in patients treated with bDMARDs (n=912) before treatment and 2 years after initiation of bDMARDs were 43.1% (3.9 mg/day) and 42.0% (3.7 mg/day), respectively. The proportion of patients taking steroid did not change over time except for ETN user, and 42.0% of bDMARD users were still treated with steroid.
Conclusion: MTX and steroid use and doses in daily practice were well adjusted after the initiation of bDMARDs, with adjustment varied depending on the bDMARD. Despite increasing remission, our study revealed steroids have been used approximately 42.0%.
To cite this abstract in AMA style:Shimizu Y, Tanaka E, Inoue E, Saka K, Sugano E, Sugitani N, Ochiai M, Yamaguchi R, Sugimoto N, Nakajima A, Ikari K, Taniguchi A, Yamanaka H. Influence of Dose Titration of Concomitant Steroid and Methotrexate during Biologic Therapy in Patients with Rheumatoid Arthritis in Daily Practice Based on the IORRA Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/influence-of-dose-titration-of-concomitant-steroid-and-methotrexate-during-biologic-therapy-in-patients-with-rheumatoid-arthritis-in-daily-practice-based-on-the-iorra-cohort/. Accessed December 10, 2019.
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