C. Thorne

The effect of rheumatoid arthritis–associated autoantibodies on the incidence of cardiovascular events in a large inception cohort of early inflammatory arthritis

Objectiven. RA is associated with an increased risk of cardiovascular events (CVEs). The objective was to estimate independent effects of RA autoantibodies on the incident CVEs in patients with early RA.nnnMethodsnPatients were enrolled in the Canadian Early Inflammatory Arthritis Cohort, a prospective multicentre inception cohort. Incident CVEs, including acute coronary syndromes and cerebrovascular events, were self-reported by the patient and partially validated by medical chart review. Seropositive status was defined as either RF or ACPA positive. Multivariable Cox proportional hazards survival analysis was used to estimate the effects of seropositive status on incident CVEs, controlling for RA clinical variables and traditional cardiovascular risk factors.nnnResultsn. A total of 2626 patients were included: the mean symptom duration at diagnosis was 6.3 months ( s . d . 4.6), the mean age was 53 years ( s . d . 15), 72% were female and 86% met classification criteria for RA. Forty-six incident CVEs occurred over 6483 person-years [incidence rate 7.1/1000 person-years (95% confidence interval 5.3, 9.4)]. The CVE rate did not differ in seropositive vs seronegative subjects and seropositivity was not associated with incident CVEs in multivariable Cox regression models. Baseline covariates independently associated with incident CVEs were older age, a history of hypertension and a longer duration of RA symptoms prior to diagnosis.nnnConclusionnThe rate of CVEs early in the course of inflammatory arthritis was low; however, delays in the diagnosis of arthritis increased the rate of CVEs. Hypertension was the strongest independent risk factor for CVEs. Results support early aggressive management of RA disease activity and co-morbidities to prevent severe complications.

The Underuse of Methotrexate in the treatment of RA: A National Analysis of Prescribing Practices in the U.S.

Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) due to its effectiveness, tolerability, and cost. This study examines MTX prescribing practices in the US from 2009 to 2014.

THU0082 An evaluation of flare in patients with early rheumatoid arthritis using the omeract preliminary flare questionnaire

Background Domains for assessment of Rheumatoid Arthritis (RA) flare identified by patients (pts) and health care professionals through OMERACT Delphi exercises have included pain, function, stiffness, participation, coping, patient global assessment (PtGAS), fatigue and self-management strategies1. Objectives To determine how these domains correspond to flare in pts with early RA. Methods Pts in the Canadian early ArThritis CoHort (CATCH) completed the OMERACT preliminary flare questionnaire (PFQ) at study visits between 11-2011 and 1- 2012. The PFQ asks pts to indicate if they are in a flare (F) or not (NF), the severity of Flare (0-10 NRS), PtGAS, levels of function, fatigue, pain, stiffness, coping, and participation (0-10 NRS), and to describe self-management strategies. At each visit rheumatologists rated whether their pt was in a flare (0-10 (VAS)). Results Of 263 pts answering the PFQ, 30% (79) reported being in a flare (F) and 70% were not in a flare (NF). Mean age (SD) in Flare group was 52.3 (16.6); 77% were female and 68.4% were RF+. RA symptom duration at time of flare ranged from <4 to >48 months. 15% of flares lasted 1-3 d, 20% 4-7 d, 12% 8-14 d, and 53% over14 d. Concordance between physicians and pts was low (kappa =0.4114) overall, but more likely with increasing severity of flare domains (Table). 5% of Flare pts sought help from a rheumatologist; 3% increased steroid doses; 58% used analgesics, and 48% reduced activities. Most used ≥1 self management strategy. Table 1. Symptom scores for pts reporting flare when MDs report patient flare or not Domain* Pt Flare/MD Flare (N=48) Pt Flare/MD Non-Flare (N=31) Flare severity (mean (SD)) 6.41 (2.6) 5.7 (2.8) Pain (mean (SD)) 6.2 (2.8) 5.5 (2.7) Function (mean (SD)) 6.0 (3.0) 4.4 (3.4) Stiffness (mean (SD)) 5.5 (3.1) 4.5 (2.9) Participation (mean (SD)) 5.7 (3.2) 3.6 (2.6) PtGAS (mean (SD)) 6.1 (2.7) 5.0 (2.5) Fatigue (mean (SD)) 5.4 (3.0) 4.7 (3.0) Coping (mean (SD)) 4.6 (2.7) 3.4 (2.6) *All domains scored 0-10 on a numerical rating score, ascending by severity. Conclusions Flares are common in early RA and agreement between patients and rheumatologists as to whether they were in a flare was low overall. Concordance is highest and directly related to increasing severity of patient reported outcomes (PROs) (pain, function, stiffness, coping, participation, PtGAS, and fatigue). PROs across multiple domains during flares are consistent with focus group, Delphi and results of others identifying heterogeneity of symptoms reported by patients when defining flare. These real life data in an early RA cohort also suggest that multiple approaches to self-management are attempted by RA pts experiencing a flare before visiting their physician. References Bartlett SJ, et al.,Arthritis Rheum 2011;63(suppl):128. Disclosure of Interest V. Bykerk Grant/Research support from: CATCH Study is supported by unrestricted research grants from Amgen, Pfizer, Abbott, BMS, Janssen, Roche, UCB, S. Bartlett: None Declared, E. Choy: None Declared, G. Boire: None Declared, C. Hitchon: None Declared, J. Pope: None Declared, C. Thorne: None Declared, B. Haraoui: None Declared, E. Keystone: None Declared, C. Bingham III: None Declared

SAT0112 Guideline-based care improves outcomes that matter to patients: tighter control, less suffering, and greater well-being over the past decade in canadian ra patients

Background Best practice recommendations can increase the quality of care and improve clinical outcomes, however, the impact of guideline-based care on outcomes that matter most to early RA patients before and after implementation of treat to target (T2T) recommendations has not been evaluated. Objectives: We compared changes over the first year of treatment in outcomes valued most by RA patients: 1) in relation to disease activity; and 2) prior (2007-10) and subsequent (2011-16) to the release of T2T and Canadian RA Recommendations. Methods: Data included early RA adults enrolled in CATCH (Canadian Early ArThritis CoHort) between 2007-16 who met 1987/2010 RA criteria with active disease at enrolment. Treatment was at the discretion of the rheumatologist and cohort investigators met annually to discuss ways to improve outcomes. We compared changes in DAS28, pain (0-10), fatigue (0-10), patient global (0-10), and HAQ-DI at 6 and 12 months prior to and after the release of guidelines using Cochran-Armitage trend tests and regression. Results: The sample included 1942 adults who were mostly female (72%) with a mean (SD) age of 55 (15), 2 (2) comorbidities, and symptom duration of 6 (3) months. At enrollment, almost all (95%) were in DAS28 moderate disease activity [MDA; 42%] or high disease activity [HDA; 53%], and were initially treated with csDMARDS (92%) and MTX (75%). CDAI, DAS28 and PROs by DAS28 disease levels are shown in the Table. Participant characteristics. Mean (SD) Total LDA MDA HDA N (%) 1942 93 (5%) 828 (42%) 1021 (53%) DAS28 5.3 (1.3) 2.9 (0.2) 4.2 (0.5) 6.2 (0.8) CDAI 28.1 (13.8) 10.8 (5.3) 19.4 (8.0) 36.9 (11.8) Patient Global (0-10) 6.0 (2.8) 3.2 (2.2) 4.9 (2.7) 7.2 (2.4) Pain (0-10) 5.7 (2.8) 3.3 (2.3) 4.6 (2.6) 6.8 (2.4) Fatigue (0-10) 5.4 (3.0) 3.8 (2.8) 4.6 (2.9) 6.1 (2.9) HAQ-DI (0-3) 1.1 (0.7) 0.6 (0.5) 0.8 (0.6) 1.4 (0.7) As mean DAS28 decreased over the year, similar improvements in patient global, pain, HAQ, and fatigue were also evident (-3.0, -2.8, -2.3, -0.6; p’s<0.001). When comparing change in PROs in the two time periods, there were more rapid improvements in patient global and pain at 6 and 12 months (p’s<0.001; figure 1) and similar improvements in HAQ and fatigue. Conclusions: Results from this large country-wide study suggest that T2T results in better disease control in the first year of RA with similar improvements in pain, fatigue, and disability--symptoms that patients identify as important--resulting in greater overall well-being. These data offer additional evidence supporting the importance of early identification and rapid control of RA to improve long-term outcomes and QOL. Acknowledgements: Sponsors: Amgen & Pfizer-Founding sponsors 2007+; UCB, AbbVie 2011+; Medexus 2013+; Eli Lilly, Sanofi- Genzyme 2016+; Merck 2017+; BMS 2011-2014, Hoffmann-LaRoche, Janssen 2011-2016 Disclosure of Interest: None declared

OP0106 Who is not reaching remission in early ra and why? predictors for persistent disease activity in the first year differ in men and women and are related to lifestyle and treatment

Background Although early identification and aggressive treatment of RA improves outcomes, we have shown that 45% of early RA participants receiving guideline-based care do not achieve remission in the first year. Moreover, fewer women reached remission than men. Objectives To compare predictors of persistent disease activity (LDA/MDA/HAD) in the 1u2009st year of RA treatment in men and women. Methods Sample included adults in CATCH (Canadian Early Arthritis Cohort) from 2007–2016 with active disease at baseline and ≥12u2009m F/U. Standardised visits included clinical assessments, questionnaires, and lab tests. Logistic regression with backward selection was used to identify predictors of failing to achieve remission (DAS28 <2.6) by 12 months among baseline sociodemographic and RA characteristics and patient reported outcomes. Results The sample included 1628 adults with classifiable RA, who were mostly female (72%) with a mean (SD) age of 55, (15) with 2 (2) comorbidities, and symptom duration of 6 (3) months. At enrollment, 95% had active disease (DAS28 MDA (42%); HDA (53%)), most were initially treated with csDMARDS (any 92%; MTX 75%). 46% of women and 38% of men did not reach remission by 12 months. Among women, multivariable results showed obesity more than doubled the likelihood of not achieving remission; other key predictors were minority status, lower education, and higher TJC and fatigue scores at baseline (table 1). In men, current smoking was associated with a 3.5 greater odds of not achieving remission in the first year; other predictors included older age, and higher pain. Not using MTX increased the likelihood of not achieving remission in women by 28% and men by 45%. Longer symptom duration and higher ESR were associated with not achieving remission in all. Factors not related to persistent disease activity included family history of RA, RF/ACPA status, erosions, SJC, HAQ and depressive symptoms at baseline.Abstract OP0106 – Table 1 Conclusions In this large pan-Canadian cohort of early RA patients receiving guideline-based arthritis care, obesity in women and current smoking in men were the strongest predictors of not achieving remission in the first 12 months followed by non-use of MTX, higher baseline inflammation and longer symptom duration. Additional poor prognostic indicators in women included minority status, lower education, and higher fatigue, whereas older age and greater pain were associated with persistent disease activity in men. Smoking cessation in men and weight reduction in women, and optimising MTX use may facilitate rapid reduction of inflammation, an essential goal of treatment in early RA. Acknowledgements Sponsors: Amgen & Pfizer-Founding sponsors 2007+; UCB, AbbVie 2011+; Medexus 2013+; Eli Lilly, Sanofi- Genzyme 2016+; Merck 2017+; BMS 2011–2014, Hoffmann-LaRoche, Janssen 2011–2016 Disclosure of Interest None declared

THU0085 Time to remission and the achievement of sustained remission in patients with early rheumatoid arthritis: site variation analysis in therapeutic strategy from the canadian early arthritis cohort (CATCH)

Background Treatment response in ERA reflects individual prognostic factors and therapeutic selection which may be influenced by provider experience and beliefs. This may lead to variations in rates of and time to remission across centres involved in multi-site cohorts. Objectives We compared therapeutic strategies across Canadian ERA clinics in relation time to CDAI and DAS28 remission, and frequency of attaining sustained remission. Methods Data were analyzed for patients with >1 year of follow-up, enrolled at sites with >40 patients at baseline and >30 patients with 2 years of follow-up data. We determined time to remission and frequency of sustained remission (2 consecutive visits at least 6 months apart), using DAS28 and CDAI scores. Treatment strategy was determined as initial and ever use of oral methotrexate monotherapy, subcutaneous methotrexate monotherapy, methotrexate-based combinations, non-methotrexate DMARDs, triple therapy, or biologic therapy. Results 1,749 participants from 13 centers with mean age 54 years, 73% female, mean DAS28 4.9 (SD 1.4) and mean CDAI 25.6 (SD 14.6) were included. There were significant differences between centers in participant characteristics (gender, age, symptom duration, body mass index, comorbidities, smoking status, education, ethnicity, marital status, seropositive status, erosions). The initial therapeutic strategies were oral methotrexate monotherapy 16% (site range 0%>55%), subcutaneous methotrexate monotherapy 15% (0%>45%), methotrexate-based combination therapy 30% (10%>47%), non-methotrexate DMARDs 19% (4%>44%), triple therapy 11% (0%>60%), and biologics 2% (0%>18%). At 60 months of follow-up, the frequency of use of these strategies was relatively stable except for biologics which increased to 21% (0%>80%). The mean and median time to DAS28 remission was 12.4 months (SD 12.1, range 8.6 to 17.2) and 9 (IQR 3, 18) months respectively. The mean and median time to CDAI remission was 14.8 (SD 13.5, range 10.3 to 21.2) and 9 (IQR 6, 18) months respectively. The frequency of sustained DAS28 remission was 50% (site range 20–70%), and CDAI 35% (12–58%). At the two sites with the highest rates of sustained remission and shortest time to remission, patients had fewer comorbidities and the initial treatment strategy was preferentially methotrexate-based combination therapies, and with eventual advancement to biologics in 7 and 39% in patients. In contrast, the patients at the site with the lowest rates of sustained remission and longest time to remission had long symptom duration at treatment initiation, highest body mass index and proportion with ≥2 comorbidities, worse socioeconomic status and higher baseline DAS28. This site also had the highest proportion of patients treated with biologics at the baseline visit, escalating to 80% by 60 months. Conclusions Treatment strategy and patient characteristics vary across CATCH sites and contribute to variable rate and frequency of achieving sustained remission. Disclosure of Interest None declared

SAT0122 Which multimorbid conditions are more prevalent around the time of early ra diagnosis and have the greatest impact on trajectories of disease activity in the first year? results from the canadian early arthritis cohort

Background Multimorbidity (MM) is highly prevalent in early RA (ERA), and higher counts of conditions are associated with poorer disease control1. It is important to understand the number of, and which specific conditions most affect disease presentation, early therapies and disease activity over time. Objectives To estimate the prevalence of MM conditions at the time of ERA diagnosis and associations with ERA clinical characteristics, early treatment, and trajectory of disease activity in the 1st year of follow up. Methods Data were from ERA patients (<1-year of symptoms) enrolled in CATCH (Canadian Early Arthritis Cohort) who met 1987 or 2010 RA criteria, and had at least two DAS28 measures in the first year. We examined baseline prevalence of: 1) cardiovascular disease (CVD), 2) diabetes, 3) cancer, 4) pulmonary disease, 5) bowel disease, 6) other rheumatic diseases, and 7) psoriasis, obtained from patient-reports of physician-diagnosed medical conditions, 8) obesity (BMI≥30), and 9) depressive symptoms (RAND-12 <42). We compared baseline demographic and clinical characteristics in ERA + each condition vs. ERA alone. We estimated adjusted effects of each condition on early use of RA therapies with logistic regression and adjusted effects of each condition on DAS28 trajectory over the first year of follow up with linear growth models. Results The sample included 1,595 patients, 1153 (72%) were female, with a mean (sd) age of 54 (15) years and 6 (3) months of symptoms. At baseline 1,434 (92%) were treated with conventional DMARDs (mostly methotrexate (76%)) and 33 (2%) with a biologic. More than 70% of ERA patients reported at least one MM, and over 30% reported 2+ MMs. Patients with MM were often older and had higher disease activity at baseline, with variations by condition. Patients with RA+CVD or depressive symptoms had a 60% and 90% higher adjusted odds of baseline steroid use, respectively (p<.001). In fully adjusted growth models, relative to patients with ERA only, patients with: a) diabetes, other rheumatic diseases or depressive symptoms had higher baseline DAS28 scores and less improvement over time, b) pulmonary disease, bowel disease, psoriasis or obesity had similar baseline DAS28 scores but less improvement over time; and c) CVD or cancer had higher baseline DAS28 scores but similar improvement over time (all p<0.05). Conclusions Multimorbidity is common in ERA patients seen in routine practice and associated with higher disease activity at baseline, less improvement over time, or both, and a greater likelihood of prescribing steroids for certain conditions. Integrating MM in to current RA care strategies may help achieve better patient outcomes. References Hitchon CA, et al. Self-reported comorbidity is common in early inflammatory arthritis and associated with poorer function and worse arthritis disease outcomes: results from the Canadian Early Arthritis Cohort. Rheumatology. 2016. doi: 10.1093/rheumatology/kew061. Disclosure of Interest O. Schieir: None declared, S. Bartlett Consultant for: UCB, Pfizer, C. Hitchon: None declared, J. Pope Grant/research support from: Amgen, BMS, Pfizer, Roche, UCB, Consultant for: AbbVie, Actelion, Amgen, Bayer, BMS, Genzyme, Hospira, Lilly, Merck, Norvartis, Pfizer, Regeneron, Roche, Sanofi, UCB, G. Boire: None declared, B. Haraoui Grant/research support from: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche and UCB, Consultant for: AbbVie, Amgen, BMS, Celgene, Eli Lilly Janssen, Merck, Pfizer, Roche and UCB, Speakers bureau: Amgen,BMS Janssen, Pfizer and UCB, E. Keystone Grant/research support from: Abbott Laboratories, Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, F.Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, Consultant for: Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Crescendo Bioscience, F Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Lilly Pharmaceuticals,Merck, Pfizer Pharmaceuticals, UCB, Speakers bureau: Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Canada, F Hoffmann-La Roche Inc, Janssen Inc, Pfizer Pharmaceuticals, UCB,Amgen, D. Tin: None declared, C. Thorne: None declared, V. Bykerk: None declared

FRI0066 The 28-Joint Disease Activity Score (DAS28) Using C-Reactive Protein Yields Lower Thresholds Compared To Conventional DAS28 with Erythrocyte Sedimentation Rate in Early Rheumatoid Arthritis

Background The interchangeability of Disease Activity Score 28 joints (DAS28) calculated using the erythrocyte sedimentation rate (ESR) versus C-reactive protein (CRP) has been questioned (1). Objectives To compare the 28-Joint Disease Activity Score (DAS28) calculated using C-reactive protein (CRP) with that using erythrocyte sedimentation rate (DAS28-ESR) in a multi-centre, usual care, early rheumatoid arthritis (ERA) cohort. Methods The present study analyzed baseline and 12-month follow up data from the Canadian Early Arthritis Cohort. The study sample included patients with RA with symptom duration less than 12 months and complete data on DAS28-ESR and DAS28-CRP at both time points. The linear association between continuous DAS28-ESR and DAS28-CRP scores was estimated using Pearsons correlation coefficient and differences across the range of DAS28 scores were examined with Bland-Altman Plots. Receiver operating characteristic (ROC) analysis was used to identify optimal thresholds for disease activity for DAS28-CRP scores that would best correspond with established DAS28-ESR thresholds in the total sample as well as in stratified samples by age and sex. Agreement between newly calculated DAS28-CRP and established DAS28-ESR thresholds was examined (kappa statistic). Results The study sample included 995 ERA patients. Sample baseline mean (SD) age was 53.7 (14.5) with 5.8 (2.9) months of symptom duration and 738 (74%) were female. Though continuous DAS28-CRP and DAS28-ESR scores were highly correlated (r=0.92, p<0.0001), Bland-Altman plots showed that DAS28-ESR scores were higher than DAS28-CRP scores across the spectrum of disease activity, with larger positive discrepancies at lower values. Positive discrepancies between DASCRP and DASESR were higher for women and patients over 60 years old. Optimal thresholds identified for the DAS28-CRP were 2.4 for remission, 2.9 for low disease activity, and 4.6 for high disease activity. Overall, there was moderate to good agreement between newly calculated DAS28-CRP and DAS28-ESR thresholds (k=0.6). Conclusions Results from this large observational study of “real-world” ERA patients showed that DAS28-CRP and DAS28-ESR scores were strongly correlated but that DAS28-CRP scores were consistently lower than DAS28-ESR scores. Differences between DAS28-CRP and DAS28-ESR were greater at lower ranges of the DAS28 and were most pronounced in women and older patients. This suggests that substituting one continuous score for the other is likely reasonable for research purposes in data analysis and that interpreting the DAS28-CRP using established DAS28-ESR thresholds may be acceptable for higher levels of disease activity, but not for lower levels, particularly not for remission. References Siemons L, Vonkeman HE, ten Klooster PM, van Riel PL, van de Laar MA. Interchangeability of 28-joint disease activity scores using the erythrocyte sedimentation rate or the C-reactive protein as inflammatory marker. Clin Rheumatol. 2014 Jun;33(6):783–9. Disclosure of Interest B. Kuriya: None declared, O. Schieir: None declared, D. Lin: None declared, J. Pope: None declared, G. Boire: None declared, B. Haraoui: None declared, C. Thorne: None declared, D. Tin: None declared, C. Hitchon: None declared, E. Keystone: None declared, V. Bykerk Grant/research support from: The CATCH study was designed and implemented by the investigators. The authors have received unrestricted grants from: Amgen Canada Inc and Pfizer Canada Inc - Founding sponsor since 2007, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation and Janssen Inc since 2011, Medexus Inc since 2014 and Eli Lilly Canada Inc since 2015.

SAT0055 Treatment Response To Conventional Disease Modifying Anti-Rheumatic Drugs (Dmards) and Biologics in Seropositive and Seronegative Patients with Early Rheumatoid Arthritis: Results from Catch (Canadian Early Arthritis Cohort)

Background Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) status may affect treatment response in early rheumatoid arthritis (ERA). Objectives To investigate differences in treatment response to disease modifying anti-rheumatic drugs (DMARDs) and biologics in ERA in seropositive versus seronegative patients for RF and/or ACPA. Methods Data were obtained from The Canadian Early Arthritis Cohort (CATCH), a prospective multi-site study of patients with ERA who met 1987 or 2010 ACR/EULAR criteria for RA, had symptom duration <1 year, were not in remission at baseline and had RF or ACPA available, DAS28 scores at baseline and follow-up. Stratified multiple linear regression compared the effects of initial treatment with methotrexate (MTX) monotherapy, MTX combination therapy (defined as MTX plus one or more conventional DMARD), biologic therapy and other therapy on change in DAS28 (D DAS) at 3 and 6 month follow up in patients who were seropositive (RF + and/or ACPA+) and seronegative (RF- and ACPA-), patients who were RF positive and RF negative, and patients who were ACPA positive and ACPA negative, respectively. All multivariable models were adjusted for baseline age, gender, education, ethnicity, symptom duration, comorbidities, erosions and pain scores. Results 1068 patients had a baseline mean (SD) age of 53.3 (15.0), symptom duration of 5.8 (3.0) months, DAS28 of 5.2 (1.3) and 74% were female. A total of 867 (81.2%) patients were seropositive and 201 (18.8%) were seronegative (RF positive 759 [66%], RF negative 385 [34%], ACPA positive 539 [61%], and ACPA negative 349 [39%]). Relative to the other therapy group, better treatment response to methotrexate combination therapy at 3 months was observed for patients who were RF+ (β: 0.45 [95% CI -0.74 to -0.17]) vs. RF- (β: 0.29 [95% CI -0.14 to 0.71]) and the combined seropositive (β: -0.29 [95% CI -0.56 to -0.02]) vs. seronegative group (β: -0.12 [95% CI -0.69 to 0.44) but not patients who were ACPA+ (β: -0.06 [95% CI -0.41 to 0.30]) vs. ACPA- (β: -0.41 [95% CI -0.84 to 0.02]), after adjusting for covariates. Similar results were observed when analyses were repeated with change in DAS at 6-months as the outcome as patients on methotrexate combination therapy who were RF+ (β: -0.47 [95% CI -0.81 to -0.13]) vs. RF- (β 0.15 [95% CI -0.39 to 0.71]) and those that were seropositive (β -0.32 [95% CI -0.65 to 0.00]) vs. seronegative (β: -0.20 [95% CI -0.97 to 0.56]) responded better to treatment. Response to other treatment strategies did not significantly differ by antibody in any grouping (Table). Conclusions In ERA, RF and ACPA status affected treatment response to MTX combination therapy, with better changes in DAS28 at 3 and 6-months in seropositive compared with seronegative patients. Given the complexity of rheumatoid arthritis management, the study findings potentially have implications for identifying prognostic indicators that may help inform therapeutic decision-making. Disclosure of Interest None declared

OP0179 Comparing Initial Treatment Strategies with Methotrexate on First Use of Biologic Therapy: Results from The Canadian Early Arthritis Cohort

Background Optimal treatment of early rheumatoid arthritis (ERA) involves a treat-to-target strategy aiming for remission. Initial use of combination DMARDs is associated with an increased likelihood of remission in ERA patients. Research suggests that combinations DMARDs can provide equivalent outcomes at lower costs than biologic DMARDs. Objectives To compare effects of initial treatment with methotrexate (MTX) monotherapy vs MTX combination therapy on time to first use of biologic DMARDs in a large multi-centre ERA cohort. Methods The Canadian Early Arthritis Cohort (CATCH) is a multi-centre prospective cohort study of patients with early RA diagnosed and treated by a rheumatologist. The present study included participants who met 1987 or 2010 ACR criteria for RA, with ≤12 months symptom duration, moderate or high disease activity based on the DAS28 at baseline and treated with MTX. Patients treated with a biologic at baseline were excluded. Patients were followed until they started a biologic or they were censored due to loss to follow up or the end of the 3-year study period. Cox proportional hazards survival analysis was used to estimate effects of oral MTX monotherapy, subcutaneous MTX monotherapy, and MTX combination therapy adjusting for age, gender, education level, symptom duration, comorbidities, seropositivity, baseline erosions, baseline DAS28, and corticosteroid use. Results 1214 patients were included with 212 first events of biologic use. At baseline, 865 (71.3%) were female with mean (sd) age of 54.4 (14.9) years, symptom duration of 5.5 (2.8) months, and DAS28 of 5.5 (1.2). Oral MTX monotherapy was used as initial treatment in 230 (19%), subcutaneous MTX monotherapy in 226 (19%), and MTX combination therapy in 730 (62%). In fully adjusted Cox regression models, patients treated with subcutaneous MTX monotherapy were half as likely to require biologics as patients treated with oral MTX monotherapy (HR =0.47, p=0.015). There was no difference between MTX combination therapy and oral MTX monotherapy (HR =0.95). Conclusions Treatment with subcutaneous MTX monotherapy was associated with a reduced use of biologics. This may be due to increased treatment efficacy compared to oral MTX. Combination DMARD therapy was not associated with longer time to biologic initiation, potentially due to funding models in Canada specifying that combination DMARD therapy must be used before biologics can be considered. This study suggests that early use of subcutaneous MTX can potentially delay the need for more expensive biologic therapies. References Joensuu JT, Huoponen S, Aaltonen KJ, et al. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PLoS One 2015; 10:e0119683. Scott DL, Ibrahim F, Farewell V, et al. Tumour necrosis factor inhibitors versus combination intensive therapy with conventional disease modifying anti-rheumatic drugs in established rheumatoid arthritis: TACIT non-inferiority randomised controlled trial. BMJ 2015; 350:h1046–h1046. Disclosure of Interest S. Gottheil Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, J. Pope Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, O. Schieir Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, G. Hazlewood Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, E. Keystone Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, S. Jamal Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, C. Barnabe Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, G. Boire Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, C. Hitchon Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, C. Thorne Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, V. Bykerk Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, D. Tin Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc, P. Haraoui Grant/research support from: Amgen Canada Inc, Pfizer Canada Inc, Hoffmann-La Roche Ltd, UCB Canada Inc, Bristol-Myers Squibb Canada, AbbVie Corporation, Janssen Inc, Medexus Inc and Eli Lilly Canada Inc