ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1455

Investigation of Poor Prognostic Factors Among Rheumatoid Arthritis Patients in Turkbio Registry

Nevsun Inanc1, Zeynep Erturk1, Gulsen Ozen1, Ediz Dalkilic2, Suleyman Serdar Koca3, Gerçek Can4, Ahmet Karatas5, Yavuz Pehlivan6, Ayten Yazici7, Ayse Cefle7, Servet Akar8, Soner Senel9, Burak Oz3, Nurullah Akkoc10, Haner Direskeneli1 and Fatos Onen11, 1Rheumatology, Marmara University, School of Medicine, Rheumatology, Istanbul, Turkey, 2Department of Internal Medicine, Division of Rheumatology, Uludag University, School of Medicine, Rheumatology, Bursa, Turkey, 3Rheumatology, Firat University, School of Medicine, Rheumatology, Elazig, Turkey, 4Rheumatology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey, 5Department of Rheumatology, Firat University, School of Medicine, Rheumatology, Elazig, Turkey, 6Rheumatology, Uludag University, School of Medicine, Rheumatology, Bursa, Turkey, 7Rheumatology, Kocaeli University, School of Medicine, Rheumatology, Kocaeli, Turkey, 8Rheumatology, Izmir Katip Celebi University, School of Medicine, Rheumatology, Izmir, Turkey, 9Rheumatology, Kayseri Erciyes University, School of Medicine, Rheumatology, Kayseri, Turkey, 10Rheumatology, Private Practice, Rheumatology, İzmir, Turkey, 11Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Monday, November 6, 2017

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy Poster II: Prognostic Factors, Imaging and Miscellaneous Reports

Session Type: ACR Poster Session B

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

Background/Purpose: TURKBIO is the Turkish version of Danish DANBIO rheumatologic database which has been established in 2011.In 2016,the EULAR RA management guideline recommended assessment of certain prognostic factors while deciding the treatment strategy after the first csDMARD failure.However, it is unknown how frequent these factors are in bDMARD and tsDMARD initiators and how they affect the treatment response in RA patients.We examined the frequency and influence of these poor prognostic factors on treatment response in bDMARD and tsDMARD initiating RA patients enrolled in TURKBIO.Methods: Seven poor prognostic factors were investigated in 898 RA patients started bDMARD and tsDMARD in TURKBIO:(1)Moderate to high disease activity(2)Elevated acute phase reactants(3)High swollen joint counts(≥4)(4)High RF/ACPA titers(5)Combinations of the above(6)Erosions(7)Failure of ≥2 csDMARDs.The frequencies of these factors at treatment initiation and influence of these on achievement of DAS28-CRP remission/remission+low disease activity(LDA) at the 6th month of treatment were evaluated in overall any bDMARD and tsDMARD-receiving RA patients and in subgroups of individual drugs including TNFinhibitors(TNFi),abatacept(ABA),rituximab(RTX),tocilizumab(TCZ)and tofacitinib(TOFA).The presence of these factors in patients who stayed on or were withdrawn from the bDMARDs and tsDMARD were also determined.Results: Among the seven prognostic factors; factors 1, 2, 4, 6 and 7 were found in over 60% of patients while factors 3 and 5 were present in about 30% of the patients.Factors 1 and 3 were more frequent in patients who were in moderate/high disease activity compared to those in remission+low disease activity at the 6th month of treatment(Table).Similarly factors1 and 3 were determined at higher percentage in non-remission than remission group(Factor 1: 93.4% vs. 82.2%, p<0.001; factor 3: 43% vs. 30.7%, p=0.002).These two factors were also significantly more frequent in patients withdrawn from the treatment than in patients who stayed on treatment(Factor 1: 93% vs. 85%, p<0.001; factor 3: 41% vs. 34%, p=0.038).In TNFi group besides factors 1 and 3, factors 5 and 7 were also significantly more frequent in non-remission group than in remission group whereas, in the RTX group, only factor 1 was significantly more frequent in remission group compared to in non-remission group. For the other bDMARDs and ts DMARD we did not find any difference in poor prognostic factors among patients who did achieve remission and did not.Conclusion: Five of the seven poor prognostic factors were detected more than half of the RA patients at bDMARD and tsDMARD initiation in TURKBIO.Patients with poor prognostic factors especially factors 1 and 3 achieved remission less frequently.Additionally, there was a relationship between bDMARDs and tsDMARD withdrawal and factors 1 and 3.The influence of these factors was mainly observed in TNFi receiving group.

Table. Frequencies of poor prognostic factors in RA patients initiating bDMARDs and tsDMARD.

Factors

Remission+low disease activity, %

Moderate+high disease activity, %

P value

Factor 1: Moderate to high disease activity

95.9

83.6

<0.001

Factor 2: Elevated acute phase reactants

100

99.5

–

Factor 3: High swollen joint counts (≥4)

47.1

31.7

<0.001

Factor 4: High RF/ACPA titers

68.3

71.9

0.465

Factor 5: Combinations of the factors 1, 2, 3, 4

31.3

25.9

0.284

Factor 6: Erosions

56.5

65.6

0.332

Factor 7: Failure of ≥2 csDMARDs

69.4

69

0.918

* Disease activity was assessed by using DAS28-CRP at the 6th month of treatment

Disclosure: N. Inanc, None; Z. Erturk, None; G. Ozen, None; E. Dalkilic, AbbVie, 2,AbbVie, MSD, Roche, UCB and Pfizer, 9; S. S. Koca, None; G. Can, None; A. Karatas, None; Y. Pehlivan, None; A. Yazici, None; A. Cefle, None; S. Akar, None; S. Senel, None; B. Oz, None; N. Akkoc, None; H. Direskeneli, None; F. Onen, None.

To cite this abstract in AMA style:

Inanc N, Erturk Z, Ozen G, Dalkilic E, Koca SS, Can G, Karatas A, Pehlivan Y, Yazici A, Cefle A, Akar S, Senel S, Oz B, Akkoc N, Direskeneli H, Onen F. Investigation of Poor Prognostic Factors Among Rheumatoid Arthritis Patients in Turkbio Registry [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/investigation-of-poor-prognostic-factors-among-rheumatoid-arthritis-patients-in-turkbio-registry/. Accessed .

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