OP0176 Five Year Outcomes of Remission Steered Treatment Including Drug Tapering Strategies in Early Arthritis Patients. (15th July 2016)

• Record Type: Journal Article
• Authors: Akdemir, G.; Heimans, L.; Goekoop, R.J.; van Oosterhout, M.; Harbers, J.B.; Bijkerk, C.; Steup-Beekman, G.M.; Lard, L.; de Sonnaville, P.B.J.; Grillet, B.A.M.; Huizinga, T.W.J.; Allaart, C.F.
• Is Part Of: Annals of the rheumatic diseases. Volume 75(2016)Supplement 2
• Page Start: 122
• Page End: 123
• Publication Date: 2016-07-15
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2016-eular.2724
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: The window of opportunity hypothesis suggests that early initiation of treatment targeted at remission in early arthritis patients may avoid chronicity of inflammation and may result in early drug-free remission (DFR). Objectives: To assess clinical outcomes of induction therapy followed by 5 years DAS-remission targeted therapy including rapid drug tapering strategies in early arthritis patients. Methods: The IMPROVED study included 610 early rheumatoid arthritis (RA, 2010 criteria) or undifferentiated arthritis (UA) patients starting with methotrexate (MTX) and tapered high dose of prednisone. Patients in early DAS-remission (ER) (disease activity score (DAS)<1.6 after 4 months) stopped prednisone and if remission persisted at t=8 months also MTX. Patients not in ER (DAS≥1.6) were randomized to MTX+sulfasalazine+hydroxychloroquine+low dose prednisone (arm 1) or MTX+adalimumab (arm 2), 50 patients were not randomized and were treated "outside of protocol" (OP). Four monthly treatment adjustments aimed at DAS<1.6; if DAS<1.6 taper/stop medication and if DAS≥1.6 restart/intensify medication. Percentages of patients in (drug free) DAS-remission after 5 years were compared between RA and UA patients and the different treatment strategies. Logistic regression analysis was used to identify predictive factors of DAS-remission and DFR after 5 years. Results: After 5 years mean±SD DAS decreased and functional ability improved in all treatment groups without differences between arm 1 and 2. 295/610 (48%) patients were in DAS-remission: 220/387 (57%) in the ER group, 31/83 (37%) in arm 1, 29/78 (37%) in arm 2 (p=0.768 arm 1 vs arm 2) and 15/50 (30%) in OP. 134/610 (22%) patients were in DFR: 105/387 (27%) in the ER group, 9/83 (11%) in arm 1, 12/78 (15%) in arm 2 (p=0.374 arm 1 vs arm 2) and 8/50 (16%) in OP. DAS-remission was achieved in similar percentages in RA and UA patients and autoantibody positive (+) vs negative (−) patients. More UA than RA patients were in DFR at year 5 (33% vs 19%, p<0.001), and the same was true for anti-citrullinated protein antibodies (ACPA)− vs ACPA+ patients (31% vs 15%, p<0.001) and rheumatoid factor (RF)− vs RF+ positive patients (28% vs 17%, p<0.001). Between anti-carbamylated antibodies (anti-CarP)+ and − patients there was no difference in DFR rates. Predictors of DAS-remission were age (OR 0.97 (95% CI 0.96–0.99)), symptom duration (0.99 (0.98–0.99)), baseline tender joint count (0.95 (0.90–1.00)) and achieving ER (1.95 (1.23–3.10)) (figure ). Predictors of DFR were symptom duration (0.99 (0.97–1.00) and ER (2.67 (1.48–4.84)). ACPA+ was mostly associated with less DFR. Conclusions: After 5 years of DAS-remission steered treatment, 48% of early RA and UA patients were in DAS-remission and 22% in DFR. Remission results were better for patients who achieved ER and who had a shorter symptom duration. Remission results were similar for RA and UA patients, randomization arms and autoantibody status, but more UA than RA patients and more autoantibody? than + patients were in DFR. Disclosure of Interest: G. Akdemir: None declared, L. Heimans: None declared, R. J. Goekoop: None declared, M. van Oosterhout: None declared, J. B. Harbers: None declared, C. Bijkerk: None declared, G. M. Steup-Beekman: None declared, L. Lard: None declared, P. B. J. de Sonnaville: None declared, B. A. M. Grillet: None declared, T. W. J. Huizinga: None declared, C. F. Allaart Grant/research support from: Year 1 of the IMPROVED study was sponsored by Abbott.