Session Information
Date: Sunday, November 5, 2017
Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Initial treatment of RA with triple csDMARD therapy can achieve remission in a proportion of patients. Others respond poorly yet must wait at least 6 months to access publically funded bDMARDs in Australia, although they may benefit from earlier introduction of bDMARDs. The purpose of this study was to identify disease activity thresholds after 3 months of csDMARDs that were associated with ACR/EULAR remission after 6 months of therapy.
Methods: Consecutive patients >18 years with treatment-naïve RA (1987 ACR or 2010 ACR/EULAR criteria) and ≥ 6 months of follow up were included. Unless contraindicated, participants received triple DMARD therapy of methotrexate, sulfasalazine and hydroxychloroquine according to a treat-to-target approach, and if these failed, leflunomide was added. At baseline, 3 and 6-months, DAS28, SDAI and CDAI were determined. Remission after 6 months was defined by ACR/EULAR 2011 definition of SDAI ≤ 3.3 without initiation of leflunomide. The sensitivity and specificity of disease activity measures at 3 months to predict the 6 month remission rate were determined by a Receiver Operated Characteristics Curve, and the magnitude of association between the optimal point on the curve and remission rate was determined. Both percentage and absolute reductions in disease activity scores were examined.
Results: Median baseline DAS28, CDAI and SDAI were 5.4, 27.7 and 30.0 respectively and 89% were initiated on triple DMARD therapy. Absolute rather than relative changes in disease activity metrics after 3 months of DMARDs were more strongly associated with RA remission after 6 months of treatment. Optimal SDAI and CDAI scores at 3 months had a stronger association with 6 month remission compared to DAS28 (Table).
|
Association between Optimal Cut-Off Points and Remission Rate after 6 Months of DMARDs |
||||
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Disease Activity Cut-Off Point after 3-Months
|
n
|
Proportion Reaching cut-point
|
Remission Rate
|
Odds Ratio (95% CI)
|
|
45% Reduction in DAS28 from Baseline |
259 |
0.24 |
0.19 |
8.8 (4.4-17.5) |
|
65% Reduction in CDAI from Baseline |
258 |
0.28 |
0.18 |
12.3 (5.9-25.6) |
|
65% Reduction in SDAI from Baseline |
250 |
0.26 |
0.18 |
8.5 (4.2-17.3) |
|
DAS28 <3.4 |
261 |
0.39 |
0.19 |
10.8 (4.9-23.5) |
|
CDAI <8.0 |
265 |
0.28 |
0.18 |
16.7 (7.8-35.7) |
|
SDAI <8.6 |
259 |
0.27 |
0.19 |
18.1 (8.4-39.1) |
Conclusion: CDAI or SDAI scores at 3 months of csDMARD treatment in early RA are highly predictive of remission after 6 months and could be useful in predicting those who may ascertain long-term remission with conventional agents, and equally in identifying those who may benefit from early bDMARD initiation. In practical terms, CDAI has the advantage of providing an immediate score compared with SDAI where the results of CRP levels are required.
To cite this abstract in AMA style:
Wiese MD, Metcalf R, Wechalekar MD, Spargo L, McWilliams L, James M, Hill C, Proudman S. Predicting Remission at 6 Months in Early Rheumatoid Arthritis Treated with Conventional Synthetic Dmards [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/predicting-remission-at-6-months-in-early-rheumatoid-arthritis-treated-with-conventional-synthetic-dmards/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/predicting-remission-at-6-months-in-early-rheumatoid-arthritis-treated-with-conventional-synthetic-dmards/