PMS15 - Improvement in Disease Activity Scores Associated with Early Versus Late Initiation of Biologic Therapy in Patients with Rheumatoid Arthritis: Results of a European Chart Review Study

Abstract

Recent research has suggested that patients may have a “window of opportunity” to reverse immune dysregulation associated with RA onset through aggressive early treatment. This study aimed to evaluate the outcomes associated with early versus late biologic treatment in RA. Adults (≥18 years) with confirmed RA diagnosis between January 2008 and December 2010, who received biologic therapy for ≥3 months and had ≥12 months follow-up were included in this retrospective, observational medical chart review study in Spain, Germany, and United Kingdom. Physicians abstracted outcomes including 28-joint disease activity scores (DAS28) alongside treatment received. Patients were classified as receiving early biologic treatment if started within 1 year of RA diagnosis. Outcomes included DAS28 reduction of ≥1.2 from scores at biologic start and remission (DAS28<2.6). Time to reaching these outcomes was evaluated using Kaplan-Meier survival curves and log rank tests. Of 328 patients included, 310 (178 early; 132 late) had DAS28 measurements and were demographically similar between early vs. late treatment (overall: mean age 47.9 at diagnosis, 71.0% female, 96.1% white). Overall, 73.5% of patients had a DAS28 decrease ≥1.2 points and 44.5% achieved remission. More early versus late biologic treated patients had a DAS28 decrease ≥1.2 (79.2% vs 65.9%, p=0.009) but there was no significant difference in the time to this decrease. More early vs. late biologic treated patients achieved remission (51.1% vs. 35.6%, p=0.009), with a significant difference in survival curves when indexing on time since RA diagnosis (p<0.001) and biologic start (p=0.024). There were no significant differences outcomes across countries. This chart review contributes to the growing literature surrounding outcomes associated with early biologic treatment. Within this study, RA patients who were treated early were more likely to achieve clinically significant improvement and to reach remission earlier in their RA disease trajectory than those treated later.