SAT0161\u2005SUSTAINED MODERATE DISEASE ACTIVITY (SMDA) IN RHEUMATOID ARTHRITIS PATIENTS ON BIOLOGIC THERAPIES IS ASSOCIATED WITH 5 YEARS FUNCTIONAL LIMITATION AND SERIOUS ADVERSE EVENTSDEVELOPMENT; EVIDENCE TO SUPPORT TREAT-TO-TARGET APPROACH FOR PATIENTS IN SMDA AND ESPECIALLY THOSE IN HIGH SMDA

Abstract

Background: Registry data have shown that treatment with biologic disease modifying antirheumatic drugs (bDMARDs) induces remission or low disease activity in up-to 50% of Rheumatoid Arthritis (RA) patients, yet 30-50% of patients remain in moderate disease activity (MDA) with limited data on their long-term prognosis 1. Objectives: To assess the long-term outcome of RA patients with sustained MDA on bDMARDs, in clinical practice. Methods: We analyzed data from the Hellenic Registry of Biologic Therapies. Disease activity, function, treatments of patients starting a bDMARD are recorded prospectively every 3-6 months. Herein, we included patients with at least 5 years of follow-up, irrespective of treatment switches. If DAS28-ESR was at the same disease activity range for at least 50% of the follow-up time, patients were assigned to one of 3 main groups: sustained remission or low disease activity (sRLDA) with DAS≤3.2, sustained moderate disease activity (sMDA) with 3.25.1. Patients in sMDA were further divided into subgroups low and high sMDA (50% of follow-up has DAS lower or greater than 4.2 respectively). Function at 5 years based on Health Assessment Questionnaire (HAQ) was the primary outcome, while cumulative serious adverse events (SAEs) and bDMARDs switches were also analyzed. Results: Out of 527 patients with available data, 90 (17%), 295 (56%) and 142 (27%) were assigned to sRLDA, sMDA and sHDA groups respectively. At baseline, sMDA patients were older, more often women, had received more csDMARDs and had higher DAS, HAQ and EuroQol status compared to sRLDA group. During follow-up, sMDA patients had more bDMARDs switches as compared to sRLDA (mean ±sd: 1.82 ±1.03 vs 1.26 ±0.53, p<0.0001). Notably, patients in sMDA had significant improvement in HAQ at 5 years compared to baseline (p<0.0001), yet they presented significantly higher HAQ compared to sRLDA group (mean ±sd: 0.55 ±0.47 vs 0.30 ±0.31, p<0.0001). Trajectories of longitudinal HAQ for groups sRLDA, sMDA and sHDA, were clearly differentiated during treatment course (Figure 1). Clusters sRLDA, sMDA and sHDA also displayed differential 5 years outcomes (p<0.0001) regarding SAEs (Figure 1). Interestingly, within sMDA patients, the low sMDA patient subgroup had better long-term outcome (p<0.05) concerning both HAQ at 5 years and cumulative SAEs as compared to patients in high sMDA subgroupFigure 1 Differential long term outcomes of patient clusters, sRLDA, sMDA and sHDA Conclusion: In clinical practice 56% of RA patients on bDMARDs have sustained MDA in spite of bDMARDs switches, presenting 5 years worse functional status and more SAEs compared to patients in sRLDA. These data support the treat-to-target approach for patients in sMDA and especially those with high sMDA. Reference [1] I. Flouri, et al., Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival. Seminars in arthritis and rheumatism43 (2014). Disclosure of Interests: None declared