Baseline Disease Activity Parameters Research Articles

Is current smoking status and its relationship to anti-cyclic citrullinated peptide antibodies a predictor of worse response to biological therapies in rheumatoid arthritis patients?

Objective: To assess the association between smoking, anti-cyclic citrullinated peptide (anti-CCP) antibody status, and clinical efficacy of biological therapies in rheumatoid arthritis (RA) patients.Method: This retrospective clinical practice setting study included 1349 RA patients from the METEOR database (aged >18 years). We collected data on sociodemographics, smoking status (smoker, <10, 10–19, and >20 cigarettes/day; ex-smoker; non-smoker), baseline disease activity parameters and anti-CCP, previous disease-modifying anti-rheumatic drugs (DMARDs), biological therapy, combined therapy (steroids and DMARDs), and follow-up disease activity. Clinical efficacy was assessed by European League Against Rheumatism (EULAR) good/moderate response rates for all aggregated biological therapies, based on both smoking and anti-CCP status.Results: The non-smoking RA patients were more often female at biological therapy initiation than the ex-smokers and smokers (91.1% vs 60.4% and 67.9%, respectively, p < 0.001), and ex-smokers were older than non-smokers and smokers (mean ± sd 56.5 ± 11.1, 53.5 ± 13.3 and 51.3 ± 11.0 years old, respectively; p < 0.001). In total, 845 (62.6%) were non-smokers, 214 (15.9%) ex-smokers, and 290 (21.5%) smokers [daily cigarettes smoked: 148 (11%) <11; 61 (4.5%) 11–20; and 81 (6%) >20]. Anti CCP-antibody status was similar in both groups. Non-smokers showed higher baseline DAS28 than ex-smokers and smokers (5.0 ± 1.5 vs 4.7 ± 1.4 and 4.7 ± 1.4, respectively; p < 0.001) and used more baseline steroids and DMARDs. A higher EULAR response rate was observed in non-smokers than in ex-smokers and smokers (73% vs 65% and 64.1%, respectively; p = 0.004). Drug survival was higher in non-smokers compared to ex-smokers and smokers [57.7 months (46.4–53.8), 38.6 (30.3–46.8), and 50.1 (41.8–58.4); p < 0.001, respectively].Conclusion: In daily clinical practice, non-smokers respond better than smokers to biological therapy, but this does not result in better drug survival.

THU0104 Risk Factors of Advanced Spinal Disease And/Or Bamboo Disease in Patients with Ankylosing Sponylitis during TNFI Treatments: HÜR-BİO REAL Life Results

BackgroundSpinal ankylosis is most important reason of functional impairment in ankylosing spondylitis (AS). In routine practice, all patients who learned diseases's name ask ankylosing posture and risk factors for ankylosis....

SAT0367 Frequency of Radiological Hip Involvement and Total Hip Replacement in A Large Single Center Spondyloarthritis Cohort with Biological Treatments: HÜR-BİO REAL Life Results

BackgroundTotal hip replacement (THR) is a favorable treatment option for severe ankylosing spondylitis (AS). However, THR may be an option for another spondyloarthritis (SpA) such as psoriatic arthritis (PsA) and...

FRI0300 Baseline Characteristics and Pattern of TOCILIZUMAB Use in Patients with Rheumatoid Arthritis: Interim Results from the Multinational, Observational ACT-UP Study

BackgroundTocilizumab (TCZ), an IL-6 receptor inhibitor, has been approved in combination with disease-modifying antirheumatic drugs (DMARDs) or as monotherapy for the treatment of adults with rheumatoid arthritis (RA).1 ACT-UP is...

SAT0370 Retention Rate of TNF Blockers is Greater in CASE of Advanced Spinal Ankylosis in Axial Spondyloarthritis: Data from the HÜR-BİO Registry

BackgroundSpinal ankylosis is one of the important factor responsible of functional impairment in ankylosing spondylitis (AS). In advanced disease, there is still the debate of the potential benefit of use...

Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register

BackgroundTreatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.ObjectiveTo evaluate trends in prescription patterns of biological agents and the subsequent outcome of...

A39: Efficacy and Safety of Methotrexate in Oligoarticular Persistent Juvenile Idiopathic Arthritis

Background/Purpose:Based on the ACR 2011 recommendations for the treatment of juvenile idiopathic arthritis (JIA) with persistent oligoarticular course methotrexate (MTX) is indicated for children with high disease activity and features of poor prognosis or if they failed intraarticular glucocorticoid steroid injections. However, no report has been published on MTX outcome in this category. Therefore our aim was to evaluate the efficacy and safety of MTX in children with oligoarticular persistent JIA.Methods:Baseline demographics, clinical characteristics and disease activity parameters have been prospectively documented in the German JIA Register. Efficacy was determined using the PedACR response criteria and the JADAS‐10. Safety assessments were based on adverse events reports from the responsible physician.Results:343 patients with a total of 2039 visits were identified (894.7 total patient‐years). 67% (n = 231) were females. The median age at JIA onset was 4.7 years (quartile (Q) 25/75 2.5/9.2). At treatment initiation the median age was 8.0 years (Q25/75 4.3/12.0) and the disease duration 1.1 years (Q25/75 0.5/3.1). ANA positivity has been found in 63.0%, HLB27 positivity in 11.1%. Prior to MTX therapy 90.1% of children have been treated with nonsteroidal anti‐inflammatory drugs (NSAIDs), 46.1% have received intraarticular glucocorticoid steroid injections. 88.3 of children were treated concomitantly with NSAIDs, 11.5% with corticosteroids and 2.6% with other disease‐modifying antirheumatic drugs.A high proportion of patients showed a significant response to treatment. Compared to baseline disease activity parameters at MTX initiation, at month 6 70.5%/61.0%/41.5%, at month 12 73.9%/63.9%/43.5% and at month 24 83.6%/80.0%/69.7% of patients met the PedACR response criteria of 30%/50%/70%. The median JADAS‐10 at treatment start was 10.0 and decreased markedly to 2.1 at month 6, 1.4 at month 12 and 1.0 at month 24. At month 6 and month 12, 83 patients (33%) and 96 patients (42%) reached preliminary criteria for inactive disease.113 children experienced 216 adverse events (AE) (24.7/100 patient–years). Four were reported as serious (0.4/100 patient–years (pj)). The most common reported AEs were nausea/vomiting (8.5/100 pj), abnormal liver enzymes (4.7/100 pj) and mild to moderate infections (3.6/100 pj). 48 children (14%) suffered from uveitis prior treatment. None of these patients flared with uveitis. Four new uveitis index cases (1.1%) were reported while on treatment.Treatment has been discontinued in 134 children for the following reasons: Inefficacy 3.2%, adverse events 9.8%, remission 24.3%, patients wish 16.5%, others 2.9%. 17 of 84 children (20.2%) who stopped MTX because of remission flared and re‐started MTX.Conclusion:MTX appears to be highly effective in oligoarticular persistent JIA. The treatment is safe and well‐tolerated. Few patients discontinued due to intolerance or inefficacy.