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Abstract Number: 1007

Smoking Signicantly Reduces Effectiveness and Long-Term Survival of Biologic Treatment in Patients with Rheumatoid Arthritis

Roger Rolon Campuzano1, Andrea Lujan Coronel Ale1, Osvaldo Luis Cerda1, Fernando Dal Pra1, Emilce E Schneeberger1, María de los Angeles Correa2, Marcos Rosemffet1, Emilio Buschiazzo3, Rodrigo Garcia Salinas4, Silvia Papasidero5, Belén Barrios5, Hernán Maldonado Ficco6 and Gustavo Citera7, 1Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina, 2Section Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina, 3Section of Rheumatology, Hospital Señor del Milagro, Salta, Argentina, Salta, Argentina, 4Section of Rheumatology, Hospital Italiano de La Plata, Buenos Aires, Argentina, La Plata, Argentina, 5Section of Rheumatology, Hospital General de Agudos “Dr. E. Tornú”, Buenos Aires, Argentina, Buenos Aires, Argentina, 6section of Rheumatology, Clinica Regional del Sud, Córdoba, Argentina, Córdoba, Argentina, 7Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Biologic agents

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Session Information

Date: Monday, November 6, 2017

Title: ARHP Epidemiology and Public Health Poster

Session Type: ACR Poster Session B

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

Background/Purpose: The introduction of biological agents has been an important advance in the
treatment of RA. However, they are not exempt from adverse events and their high cost limits ac-
cess and maintenance of treatment in many circumstances. Our aim was to evaluate the biological
treatment patterns in RA patients and their accumulated survival and long-term efficacy using the
LUNDEX index.
Methods: Patients ≥ 18 years of age who met ACR/EULAR 2010 criteria for RA and who had
started their first biological disease modifying drugs (b-DMARD) between 01/2006 and 12/2017
were included. Socio-demographic variables such as age, sex, employment status, marital status,
health coverage, education and number of cohabitants, as well as comorbidities, smoking status
(current, past), date of onset of symptoms, disease characteristics and previous DMARDs treatment
were recorded. Disease activity and functional capacity were assessed before and after biologic
treatment using CDAI and HAQ, respectively. Cumulative drug survival was assessed by Kaplan
Meier curves and comparisons using log Rank. LUNDEX was calculated as the product of efficacy
(CDAI remission or low disease activity) and percentage of patients who continued to receive bio-
logical treatment at different cut-off times
Results: 347 patients were included, 89.6% were female, median age was 57.80 years (IQR 48-65),
96.5% had positive rheumatoid factor and 60.8% had positive anti-CCP. 70.6% of patients had
health insurance, 79,8% were smokers and 47% of them had comorbilities. The first bDMARD
was etarnecept in 46.8%, adalimumab (ADA) 28.9, certolizumab 7.2%, abatacept 6.4%, golimumab
4.3, tocilizumab 2.6%, rituximab 2.3% and infliximab 1.4%. Only 5.6% of patients received mono-
therapy, 53.9% of patients discontinued treatment with bDMARD, and the causes of discontinua-
tion were: lack of provision (33.5%), inefficacy (33%), adverse events (20.3%). Out of the available
data the most frequent adverse event was infection. The median survival of the first biological was
31 months (95%CI: 21.8-40.1), without differences between different drugs. CDAI significantly im-
proved over time. Lundex was 45.5% at 6 months and 41.1% at one year. CDAI at 6 months was
significantly lower in non smokers vs smokers (11.37±9.6 vs 17.71±14, p=0.03). In Cox regression
analysis, smoking status (HR 1.8, 95%CI:1.2-2.8) and younger age (HR: 0.98, 95%CI: 0.96-0.99)
were independently associated with lower bDMARD survival rates.
Conclusion: Socioeconomic factors impact on biological survival in our region. Smoking signifi-
cantly reduces the effectiveness of biological treatment, as well as it reduces drug survival.

Disclosure: R. Rolon Campuzano, None; A. L. Coronel Ale, None; O. L. Cerda, None; F. Dal Pra, None; E. E. Schneeberger, None; M. D. L. A. Correa, None; M. Rosemffet, None; E. Buschiazzo, None; R. Garcia Salinas, None; S. Papasidero, None; B. Barrios, None; H. Maldonado Ficco, None; G. Citera, None.

To cite this abstract in AMA style:

Rolon Campuzano R, Coronel Ale AL, Cerda OL, Dal Pra F, Schneeberger EE, Correa MDLA, Rosemffet M, Buschiazzo E, Garcia Salinas R, Papasidero S, Barrios B, Maldonado Ficco H, Citera G. Smoking Signicantly Reduces Effectiveness and Long-Term Survival of Biologic Treatment in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/smoking-signicantly-reduces-effectiveness-and-long-term-survival-of-biologic-treatment-in-patients-with-rheumatoid-arthritis/. Accessed .
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