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Abstract Number: 587

The Superiority of a Treat to Target Strategy over Conventional Treatment with Fixed Csdmard and Corticosteroids: A Multi-Centre Randomized Controlled Trial in RA Patients with Inadequate Response to Conventional Synthetic Dmards, and a New Therapy with Certolizumab Pegol

Ruediger Mueller1, Michael Spaeth2, Cord von Restorff3, Christoph Ackermann4 and Johannes von Kempis5, 1Division of Rheumatology, Kantonsspital St Gallen, St. Gallen, Switzerland, 2Division of Rheumatology, Spital Linth, Uznach, Switzerland, 3Private rheumatologic practice, Männedorf, Switzerland, 4Private rheumatologic practice, Triesen, Liechtenstein, 5Division of Rheumatology and Immunology, Kantonsspital St. Gallen, St. Gallen, Switzerland

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: certolizumab pegol, DMARDs, rheumatoid arthritis (RA) and treatment

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Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Treatments Poster I: Strategy and Epidemiology

Session Type: ACR Poster Session A

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

The superiority of a treat to target strategy over conventional treatment with fixed csDMARD and corticosteroids: a multi-centre randomized controlled trial in RA patients with inadequate response to conventional synthetic DMARDs, and a new therapy with certolizumab pegol.

Ruediger B. Mueller1,2, Michael Spaeth3, Cord von Restorff4, Christoph Ackermann5, Johannes von Kempis1

1 Division of Rheumatology and Immunology, Kantonsspital St. Gallen, St. Gallen, Switzerland

2 Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich

3 Division of Rheumatology, Spital Linth, Uznach, Switzerland

4 Private rheumatologic practice, Männedorf, Switzerland

5 Private rheumatologic practice, Triesen, Liechtenstein

Background/Purpose: Treatment of rheumatoid arthritis (RA) includes the use of conventional (cs), biologic (b) disease-modifying anti-rheumatic drugs (DMARDs) and oral or intraarticular (IA-) glucocorticoids (GCs).

To analyse whether a treat to target (T2T) strategy optimizing csDMARD, oral and IA-GC treatment as an adjunct new therapy to a new certolizumab pegol (CZP) therapy in RA patients improves effectivity in RA patients.

Methods: 43 patients with active RA (≥ 6 tender, ≥ 6 swollen joints, ESR ≥ 20mm/h or CRP ≥ 7mg/l) despite csDMARD treatment for ≥ 3 months and naïve to bDMARDs were randomized to CZP (200mg/2 weeks after loading with 400mg at weeks 0-2-4) plus a treat to target strategy (T2T, n=21) or to CZP added to the established csDMARD therapy (fixed regimen, n=22). The T2T strategy consisted of changing the baseline csDMARD therapy (1) SC-methotrexate (dose: 15=>20=>25mg/week, depending on the initial dose) => leflunomide (20mg/d) => sulfasalazine (2x1000mg/d) plus (2) oral GCs (20-15-12.5-10-7.5-5-2.5-0mg/d tapered every 5 days) and (3) injections of ≤5 affected joints with triamcinolone. DMARD modification and an addition of oral GCs were initiated depending on the achievement of low disease activity (DAS28 <3.2). The primary objective was defined as the ACR50 response at week 24.

Results: ACR 50 was achieved in 76.2% of the T2T as compared to 36.4% of the fixed regimen patients (p=0.020). ACR 20 and 70 responses were achieved in 90.5% and 71.4% of the T2T patients and 59.1% and 27.3% of the fixed regimen patients, respectively (p=0.045 and p=0.010, resp.). The adverse event rate was similar for both groups (T2T n=51; fixed regimen n=55).

Conclusion: Treat to target management with optimization of csDMARDs, oral and IA-GCs of RA patients in parallel to a newly established CZP treatment was safe and efficacious in comparison to a fixed regimen of csDMARDs background therapy.

UCB Pharma funded this study. Gebro Pharmaceuticals provided the csDMARDs and GCs for the study.

Macintosh HD:Users:rudigermuller:Desktop:FIGURE ACR ABSTRACT.pdf


Disclosure: R. Mueller, UCB, Inc., 5; M. Spaeth, None; C. von Restorff, None; C. Ackermann, None; J. von Kempis, UCB, Inc., 5.

To cite this abstract in AMA style:

Mueller R, Spaeth M, von Restorff C, Ackermann C, von Kempis J. The Superiority of a Treat to Target Strategy over Conventional Treatment with Fixed Csdmard and Corticosteroids: A Multi-Centre Randomized Controlled Trial in RA Patients with Inadequate Response to Conventional Synthetic Dmards, and a New Therapy with Certolizumab Pegol [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-superiority-of-a-treat-to-target-strategy-over-conventional-treatment-with-fixed-csdmard-and-corticosteroids-a-multi-centre-randomized-controlled-trial-in-ra-patients-with-inadequate-response-to/. Accessed .
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