THU0135 PATIENT GLOBAL ASSESSMENT LEVELS PRECLUDE THE MAJORITY OF RHEUMATOID ARTHRITIS PATIENTS OTHERWISE IN REMISSION, FROM REACHING THIS STATUS: SYSTEMATIC LITERATURE REVIEW AND META-ANALYSES INCLUDING 23,297 PATIENTS

Abstract

Background: Based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based remission definition for rheumatoid arthritis (RA), the main reason for near-misses (failing Boolean remission solely due to one criterion >1) is a patient global assessment (PGA) >1/10.1-3 The frequency of this PGA-near-remission status has not been well established. Objectives: To synthesize the overall prevalence of ACR/EULAR Boolean-based remission and PGA-near-remission cross-sectionally in published studies, and to explore association with disease duration. Methods: We systematically searched PubMed database (from 1/jan/2011 till 15/jan/2020) for “Rheumatoid arthritis” AND Boolean [OR synonyms] AND PGA [OR synonyms], and carried out a hand search of the references of the included studies. Two reviewers independently assessed the study inclusion and extracted the data (n (%) of patients in each remission status, mean (SD) disease duration, and country/city). Studies were excluded if any of the four Boolean criterion was not considered (e.g. C-Reactive Protein not assessed), or if only patients with low disease activity or remission were selected. If different time assessments were provided, we selected the 1y follow-up, as the most common. Random effects meta-analyses of proportions with double arcsine transformation were performed (also by disease duration subgroups) using MEDCALC®. Heterogeneity was assessed by I2. Results: From 41 studies identified, 8 studies concerning 12 subsamples were analysed (n=23,297 patients; of which 22% had ≤2 years mean disease duration). The overall prevalence of Boolean remission was 12% (95%CI: 10-15%, p Conclusion: The overall prevalence of PGA-near-remission in patients with RA followed in clinical practice was 1/3 more prevalent than Boolean remission, a difference more pronounced in patients with established disease. Overall, over 61% of all RA patients otherwise in remission failed to satisfy the Boolean definition of remission solely due to a PGA>1. The use of PGA in the definition of treatment target exposes a substantial proportion of patients to the risk of overtreatment with immunosuppressive agents, while being deprived of the adjunctive therapy they probably need.