Session Type: Poster Session C
Session Time: 1:00PM-3:00PM
Background/Purpose: With a wide range of disease modifying treatment available, clinical remission is frequently achieved in rheumatoid arthritis (RA). Although a proportion of RA-patients achieves clinical remission on the anchor drug methotrexate (MTX), around 50% of RA-patients require (combination) therapy with a biological DMARD (bDMARD).1 At disease presentation, it is challenging to determine which DMARD-strategy is required for each RA-patient to achieve remission. In this study we combined clinical, laboratory and imaging measures to predict which RA-patients achieve clinical remission on initial MTX-monotherapy and which patients achieve remission on initial treatment with abatacept (ABA) and MTX.
Methods: 1131 ACPA-positive RA-patients from the AVERT 1 and 2 were studied: 388 treated with MTX-monotherapy, 743 treated with ABA+MTX (table 1). Stepwise backward logistic regression was used to determine which clinical baseline characteristics were predictive of DAS28-remission after 6 and 12 months. Clinical characteristics which were included in the model were age, sex, smoking (ever), symptom duration, weight, HAQ-DI and DAS28CRP. Bootstrapping was applied to correct for model-optimism (50 replications). Serological (ACPA, RF, total IgG/IgA/IgM-levels), imaging (MRI-detected synovitis/osteitis/erosions) and genetic (HLA-shared epitope) measures were added to the models to study whether this improved predictive performance. 148 ACPA-positive RA-patients from the Leiden early arthritis cohort were selected as external validation MTX-population.
Results: In the MTX-monotherapy group, 27% and 39% of patients achieved DAS28-remission after 6 and 12-months. In the ABA+MTX group this was 43% and 53%. The consistent factor which appeared predictive for clinical remission in all models and in both treatment groups was baseline DAS28CRP (table 2). Optimism-adjusted model performance (AUROC) for DAS28-remission at 6 and 12-months was 0.66/0.65 in the MTX-group and 0.68/0.59 in the ABA+MTX-group. Adding baseline MRI-detected joint-inflammation, baseline serology or HLA-shared epitope alleles did not significantly improve model performance (table 3). In the Leiden EAC, the MTX-validation population, models had comparable predictive performance; 0.68/0.57 for DAS28-remission at 4 and 12-months (table 2).
Conclusion: Determining which patients achieve clinical remission upon MTX or ABA+MTX treatment remains challenging using clinical and imaging variables at diagnosis. Disease activity at disease presentation appeared most important for achieving clinical remission after 1 year.
To cite this abstract in AMA style:Verstappen M, Niemantsverdriet E, Huizinga T, van der Helm-van Mil A, Bergstra S. Predictors of Achieving Clinical Remission in ACPA-positive RA-patients Treated with Abatacept and Methotrexate or Methotrexate Monotherapy [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/predictors-of-achieving-clinical-remission-in-acpa-positive-ra-patients-treated-with-abatacept-and-methotrexate-or-methotrexate-monotherapy/. Accessed .
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-achieving-clinical-remission-in-acpa-positive-ra-patients-treated-with-abatacept-and-methotrexate-or-methotrexate-monotherapy/