FRI0127 Outcomes of disease activity in a 5-year large cohort of rheumatoid arthritis patients treated under treat to target recommendations and a multidisciplinary care model – a real-life experience

Background: Data regarding the real-life predictors of low disease activity (LDA) in rheumatoid arthritis (RA) patients are limited. Our aim was to evaluate the rate and predictors of LDA and treatment patterns in RA. Methods: This was a multicenter, prospective, RA cohort study where patients were evaluated in two different time points approximately 12 months apart. Statistical analysis was performed in order to identify predictors of LDA while patterns of disease-modifying anti-rheumatic drug [DMARDs; conventional synthetic (csDMARD) or biologic (bDMARD)] and glucocorticoid (GC) use were also recorded. Results: The total number of patients included was 1317 (79% females, mean age: 62.9 years, mean disease duration: 10.3 years). After 1 year, 57% had achieved LDA (DAS28ESR<3.2) while 43% did not (34%: moderate disease activity: DAS28ESR ⩾3.2 to <5.1, 9%: high disease activity, DAS28ESR ⩾5.1). By multivariate analysis, male sex was positively associated with LDA [odds ratio (OR) = 2.29 p < 0.001] whereas advanced age (OR = 0.98, p = 0.005), high Health Assessment Questionnaire (HAQ) score (OR = 0.57, p < 0.001), use of GCs (OR = 0.75, p = 0.037) or ⩾2 bDMARDs (OR = 0.61, p = 0.002), high co-morbidity index (OR = 0.86, p = 0.011) and obesity (OR = 0.62, p = 0.002) were negative predictors of LDA. During follow-up, among active patients (DAS28ESR >3.2), 21% initiated (among csDMARDs users) and 22% switched (among bDMARDs users) their bDMARDs. Conclusion: In a real-life RA cohort, during 1 year of follow-up, 43% of patients do not reach treatment targets while only ~20% of those with active RA started or switched their bDMARDs. Male sex, younger age, lower HAQ, body mass index and co-morbidity index were independent factors associated with LDA while use of GCs or ⩾2 bDMARDs were negative predictors.

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FRI0031 Better Outcomes of Disease Activity in A Large Cohort of Rheumatoid Arthritis Patients Treated under Treat to Target Recommendations:

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.4830 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 392.1-392

Author(s):

A. Palomino ◽

V. Giraldo ◽

P. Santos-Moreno ◽

G. Saavedra-Martinez ◽

L. Villarreal ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Large Cohort ◽

Treat To Target

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Predicting achievement of the treatment targets at 6 months from 3-month response levels in rheumatoid arthritis: data from real-life follow-up in the NOR-DMARD study

RMD Open ◽

10.1136/rmdopen-2018-000773 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000773 ◽

Cited By ~ 6

Author(s):

Vibeke Norvang ◽

Joseph Sexton ◽

Eirik K Kristianslund ◽

Inge C Olsen ◽

Till Uhlig ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Activity Index ◽

Real Life ◽

Disease Activity Index ◽

Current Treatment ◽

Treat To Target ◽

Likelihood Ratios ◽

Treatment Targets ◽

Factor Inhibitor

ObjectiveWhen initiating a new therapy in patients with rheumatoid arthritis (RA), current treatment recommendations suggest escalating therapy in case of poor clinical improvement by 3 months or if the treatment target has not been reached by 6 months. We investigated which disease activity improvement levels at 3 months predicted achievement of the treatment targets at 6 months in a real-life clinical setting.MethodsWe included 1610 patients with RA enrolled in the NOR-DMARD study between 2000 and 2012. Analyses were performed for the total group of patients and repeated for subgroups stratified by baseline disease activity, disease duration or treatment with methotrexate or a tumour necrosis factor inhibitor. We used a diagnostic test approach to explore the associations between 3-month response and 6-month outcome.ResultsNot achieving 50% improvement in Simplified Disease Activity Index (SDAI) by 3 months significantly decreased the likelihood of reaching remission at 6 months in all subgroups (negative likelihood ratios (LRs−) 0.15–0.36). Patients with high disease activity when initiating treatment were likely to fail reaching remission if they achieved less than SDAI 70% response by 3 months (LR− 0.25 and negative predictive value 0.98). Achieving a major response (SDAI 85%) at 3 months significantly increased the likelihood of reaching remission at 6 months (LRs+ 6.56).ConclusionLevels of 3-month disease activity improvement can inform clinicians when deciding to continue or adjust ongoing therapy in a treat-to-target strategy aiming for remission or low disease activity within 6 months. The required levels of 3-month improvement varied with baseline disease activity.

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THU0172 Improvement of disease activity in a 5-year cohort of rheumatoid arthritis patients treated under treat to target recommendations and a multispeciality care model receiving conventional dmard therapy

10.1136/annrheumdis-2017-eular.5592 ◽

2017 ◽

Author(s):

P Santos-Moreno ◽

D Gomez ◽

E Castillo ◽

R Giraldo ◽

G Ballesteros ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Treat To Target ◽

Care Model ◽

Dmard Therapy

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POS1182 MANAGEMENT OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS DURING THE COVID-19 PANDEMIC: EVIDENCE FROM THE ITALIAN EPICENTER

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1188 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 872.1-872

Author(s):

F. Ingegnoli ◽

A. F. Luppino ◽

G. Cincinelli ◽

E. Favalli ◽

R. Caporali

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Control Strategy ◽

Targeted Therapies ◽

Activity Index ◽

Real Life ◽

Treat To Target ◽

Tight Control ◽

Face To Face

Background:Despite significant improvement in the RA management, up to twenty percent of patients with rheumatoid arthritis (RA) have a difficult-to-treat (D2T) disease. The COVID-19 related mitigation policies, for instance quarantine, and consequent difficult access to in-person visits, laboratory and imaging investigations, adversely affected the follow up of rheumatic patients. Although pandemic-imposed limitations could have negatively influenced disease management particularly in D2T patients, to what degree these restrictions affected the treat-to target (T2T) and tight-control strategy in this subgroup of RA patients has not been investigated yet.Objectives:To evaluate whether the switch to telehealth imposed by COVID-19 pandemic was effective in the management of D2T RA patients treated with targeted therapies.Methods:This observational retrospective real-life study was conducted from November 2019 through September 2020. Among RA patients treated with targeted therapies, RA D2T patients according to EULAR definition (1) were identified. Clinical Disease Activity Index (CDAI) of these patients was analysed retrospectively before, during and after lockdown (LD). During LD period, patients could choose whether to receive home drug delivery or to maintain their face-to-face consultations, and in the former rheumatologists provided virtual care. To evaluate the effect of LD on the percentage of patients in remission, logistic mixed effects regression models were fitted, with CDAI remission as response variable.Results:Data were extracted from a longitudinal observational registry, and at baseline, 52 patients treated with targeted therapies were classified as D2T RA. Among them, during pre-LD, LD, and post-LD 11.54% (N=6), 53.49% (N=23), and 46.15% (N=24) had CDAI remission/low disease activity, while 46 (88.46%), 20 (46.51%) and 28 (53.85%) had CDAI moderate/high. All the patients completed the follow-up. Median values of CDAI during pre-LD, LD, and post-LD were 14.5 [IQR 12-21], 9 [IQR 5.5-16], and 11 [IQR 6-19.2] respectively (see Figure 1 below).Conclusion:Telephone-based tight control strategy ensured satisfactory management of D2T RA treated with targeted therapies. This temporary approach has been a feasible compensation for the decline of face-to-face visits also in this challenging group of RA patients, thus reassuring for future months before the end of pandemic.References:[1]Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80(1):31-35.Disclosure of Interests:Francesca Ingegnoli: None declared, Angela Flavia Luppino: None declared, Gilberto Cincinelli: None declared, Ennio Favalli Speakers bureau: AbbVie, Sanofi-Genzyme, Lilly, UCB, Pfizer, Novartis, Janssen, Paid instructor for: Roche, MSD, Consultant of: Lilly, Galapagos, Roberto Caporali Speakers bureau: Abbvie, Amgen, BMS, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly,Janssen, MSD.

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Hypogammaglobulinemia after rituximab for rheumatoid arthritis is not rare and is related with good response: 13 years real-life experience

Rheumatology ◽

10.1093/rheumatology/keaa617 ◽

2020 ◽

Author(s):

Gerasimos Evangelatos ◽

George E Fragoulis ◽

Kalliopi Klavdianou ◽

Melina Moschopoulou ◽

Dimitrios Vassilopoulos ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Corticosteroid Therapy ◽

Life Experience ◽

Real Life ◽

Low Disease Activity ◽

Disease Outcomes ◽

Lower Baseline ◽

Serious Infections ◽

Baseline Levels

Abstract Objectives Rituximab (RTX) use in the treatment of RA can be complicated by decrease in IgG, IgM or IgA levels (hypogammaglobulinemia-HGG). The aim of this study was to define the frequency of HGG in RA patients treated with RTX and to identify associations between its occurrence and patients’ characteristics, disease outcomes and serious infections rate. Methods RA patients treated with RTX in two rheumatology centers from January 2007 to January 2020 were retrospectively examined. Demographical, clinical and laboratory parameters were recorded at baseline and at last visit. Results Eighty-three patients (84.3% females) with a mean age of 63.2 years were enrolled. They had baseline DAS28(CRP) of 5.2 (1.1) and received a median (range) of 8 (2–20) RTX cycles. A total of 43.4%, 24.1% and 31.3% developed ‘any HGG’, ‘low IgG’ and ‘low IgM’, respectively. Lower baseline IgG and IgM levels were predictors of ‘low IgG’ and ‘low IgM’ occurrence, respectively. Patients who developed ‘low IgM’ exhibited lower DAS28(CRP) and increased rates of remission and low disease activity compared with those with normal IgM levels. Patients who maintained normal IgG were receiving methotrexate more frequently. No differences were observed in serious infections rate among subgroups. Conclusion HGG occurred in 43% of RTX-treated patients. Patients who developed low IgG or low IgM had lower baseline levels than those who did not. Concomitant DMARD and corticosteroid therapy was not associated with HGG. Low IgM, but not low IgG, development was associated with better disease outcomes. HGG was not associated with an increased incidence of serious infections.

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