ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1715

Longitudinal Patterns of Remission in Real-World Early Rheumatoid Arthritis Patients: Results from the Canadian Early Arthritis Cohort (CATCH)

Orit Schieir1, Glen Hazlewood2, Susan Bartlett3, Marie-France Valois3, Louis Bessette4, Gilles Boire5, Carol Hitchon6, Edward Keystone7, Janet Pope8, Carter Thorne9, Diane Tin9, Vivian Bykerk10 and Canadian Early Arthritis Cohort (CATCH) Investigators11, 1Canadian Early Arthritis Cohort Study, Montreal, Canada, 2University of Calgary, Calgary, AB, Canada, 3McGill University, Montreal, Canada, 4Laval University, Quebec, Canada, 5Universite de Sherbrooke, Sherbrooke, Canada, 6University of Manitoba, Winnipeg, MB, Canada, 7The Rebecca MacDonald Centre for Arthritis, Mt. Sinai Hospital, Toronto, Canada, 8Department of Medicine, University of Western Ontario, St. Joseph's Health Centre, London, ON, Canada, 9Southlake Regional Health Centre, Newmarket, ON, Canada, 10Hospital for Special Surgery, New York, NY, 11Canadian Early Arthritis Cohort (CATCH) Study, Toronto, Canada

Meeting: ACR Convergence 2020

Keywords: , , ,

Session Information

Date: Monday, November 9, 2020

Title: RA – Diagnosis, Manifestations, & Outcomes Poster IV: Lifespan of a Disease

Session Type: Poster Session D

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

Background/Purpose: Early diagnosis and rapid initiation of DMARDs following a treat-to-target approach have made remission a realizable goal for many persons living with RA. Despite contemporary improvements in early RA remission outcomes, less is known about: How often, and  how long remission is sustained for, and what factors may contribute to loss of remission/ disease control over time. The objective of the present study was to describe longitudinal patterns of remission in real-world early RA patients over a 12-24 months follow up period.

Methods: Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH), a prospective study of “real-world” early RA patients (symptoms < 1 year) treated in rheumatology clinics across Canada from 2007- 2019. The study sample was limited to patients with active disease at enrolment who later reached remission (SDAI< =3.3) and were followed for 12-24 months post-remission. SDAI remission status over the 12-24m follow up period was classified into 3 patterns: Pattern 1 - Sustained remission (REM → REM); Pattern 2 - Transient remission  (REM → LDA), and Pattern 3 - Transient remission (REM → MDA/HDA). Multi-adjusted multinomial regression was used to identify predictors of transient remission patterns (Pattern 2 and Pattern 3) vs. sustained remission (Pattern 1), respectively.

Results: Among all early RA patients enrolled in CATCH, 1691/ 3054 (55%) had ever reached SDAI remission. Among those that reached remission, 1,419 completed at least 12-24 months of study follow-up post remission and were included in the present study. At study enrolment, most were female (70%), mean(sd) SDAI disease activity was high (27(15)) and most patients (92%) were being treated with csDMARDs. Over the follow up period, 47% of patients sustained remission by 12-months and, only 40% by 24 months (Figure). Transitions from REM→LDA (36%) were more common than REM→MDA/HDA (15%) by 24 months (Figure).Female sex, smoking, higher comorbidity index and positive serology, were significantly associated with transient remission patterns (Table). Results also suggest possible associations between  transient remission patterns and older age, longer time to first remission, lack of early MTX treatment and reducing treatment after remission, but confidence intervals were inconclusive (Table).

Conclusion: Results of this large longitudinal study suggests that < 50% of real-world early RA patients that reached remission, sustained remission for 12-24m. Closer monitoring of RA patients with prognostic indicators for transient remission, and additional research aimed at improving the understanding of why remission is lost may help more patients sustain remission for longer periods.

Figure – Distribution of Disease Activity Status 12-24 after RA Patients First Reach SDAI REM

Table. Multi-Adjusted Multinomial Regression Results of Predictors of Transient Remission Patterns over 24-Month Follow Up

Disclosure: O. Schieir, None; G. Hazlewood, None; S. Bartlett, Pfizer, 1, UCB, 1, Lily, 1, Novartis, 1, Merck, 1, Janssen, 1, Abbvie, 1; M. Valois, None; L. Bessette, Amgen, 1, 2, 3, BMS, 1, 2, 3, Janssen, 1, 2, 3, UCB, 1, 2, 3, AbbVie, 1, 2, 3, Pfizer, 1, 2, 3, Merck, 1, 2, 3, Celgene, 1, 2, 3, Sanofi, 1, 2, 3, Lilly, 1, 2, 3, Novartis, 1, 2, 3, Gilead, 2, 6, 8; G. Boire, Amgen, 1, 2, BMS, 1, 2, 3, Celgene, 1, Merck, 1, 2, Pfizer, 1, 2, 3, Eli Lilly, 1, 2, Janssen, 1, Abbvie, 1, Novartis, 1, Sandoz, 1; C. Hitchon, None; E. Keystone, Abbot, 2, 5, 8, Amgen, 2, 5, 8, AstraZeneca, 2, 5, 8, Biotest, 2, 5, 8, Bristol-Myers Squibb, 2, 5, 8, F. Hoffmann-La Roche Inc., 2, 5, 8, Janssen, 2, 5, 8, Eli Lilly and Company, 2, 5, 8, Genentech, 2, 5, 8, Merck, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Sanofi-Aventis, 2, 5, 8, UCB, 2, 5, 8; J. Pope, AbbVie, 2, 5, Amgen, 5, 8, Lilly, 2, 5, 8, UCB, 2, 5, 8, Sanofi, 5, 8, Sandoz, 5, 8, Roche, 2, 5, 8, Pfizer, 5, 8, Novartis, 5, 8, Merck, 2, 5, 8, Janssen, 5, 8, Gilead Sciences, Inc., 2, 5, BMS, 2, 5, 8, Abbott, 5, Actelion, 5, AstraZeneca, 5, Bayer, 5, Boehringer Ingelheim, 5, EICOS, 5, Emerald, 5, GlaxoSmithKline, 5, Medexus, 5, Seattle Genetics, 2; C. Thorne, Abbvie, 1, 2, Amgen, 1, 2, Celgene, 1, 2, CaREBiodam, 1, Centocor, 1, Janssen, 1, Lilly, 1, Medexus/Medac, 1, 2, Merck, 1, Novartis, 1, 2, Pfizer, 1, 2, Sanofi, 1; D. Tin, None; V. Bykerk, Amgen, 2, 5, UCB, 5, National Institute of Health, 2, 9, Bristol-Myers Squibb Company, 2, 5, Gilead, 5, Pfizer, 5, Brainstorm Therapeutics, 1, 3; C. (CATCH) Investigators, Amgen, 2, Pfizer Canada, 2, Medexus Inc., 2, Eli Lilly Canada, 2, Merck Canada, 2, Sandoz Canada, Biopharmaceuticals, 2, Gilead Sciences Canada, 2, Hoffmann-LaRoche, 2, Janssen Biotech, 2, UCB Canada, 2, Bristol-Myers Squibb Canada, 2, Sanofi Genzyme, 2, AbbVie Corporation, 2.

To cite this abstract in AMA style:

Schieir O, Hazlewood G, Bartlett S, Valois M, Bessette L, Boire G, Hitchon C, Keystone E, Pope J, Thorne C, Tin D, Bykerk V, (CATCH) Investigators C. Longitudinal Patterns of Remission in Real-World Early Rheumatoid Arthritis Patients: Results from the Canadian Early Arthritis Cohort (CATCH) [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/longitudinal-patterns-of-remission-in-real-world-early-rheumatoid-arthritis-patients-results-from-the-canadian-early-arthritis-cohort-catch/. Accessed .

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