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FRI0063 Comparison of disease characteristics of RA patients in remission according to the DAS criteria versus the new ACR/EULAR criteria in a real-world patient population
  1. D. Choquette1,
  2. W. Bensen2,
  3. M. Sheriff3,
  4. J. Kelsall4,
  5. M. Baker5,
  6. J. Sampalis6,
  7. S. Otawa7,
  8. S. Khalil8
  1. 1University of Montreal, Montreal, QC
  2. 2McMaster University, Hamilton, ON
  3. 3Nanaimo Regional General Hospital, Nanaimo, BC
  4. 4Mary Pack Arthritis Centre, Vancouver, BC
  5. 5University of Victoria, Victoria, BC
  6. 6JSS Medical Research, Montreal, QC
  7. 7Janssen Canada Inc, Toronto
  8. 8Janssen Canada Inc, Montreal, QC, Canada

Abstract

Background The commonly used remission criteria DAS-ESR and DAS-CRP rather define minimal disease activity than remission. ACR/EULAR recently developed new definitions of remission1 (A/E criteria) that reflect more accurately a patient population in clinical remission. ACR/EULAR also endorses the definition of remission according to the SDAI (SDAI≤3.3). The purpose of this analysis is to compare the performance of the different remission criteria in a real-world Canadian patient population treated with infliximab (IFX).

Methods BioTRAC is an ongoing, non-interventional study of patients (pts) starting IFX as first biologic or after having been treated with a biologic for less than six months. Pts with rheumatoid arthritis (RA) who have been enrolled for at least 6 months (mo) ago are included in this analysis. Remission rates at 6 mo are based on a modified ITT analysis, including all pts with sufficient information reported.

Results A total of 775 established RA patients were included in this analysis. At 6 mo 33%, 28%, 17% and 8% of the pts achieved remission as defined by DAS28-CRP (≤2.6), DAS28-ESR (≤2.6), SDAI (≤3.3) or the A/E criteria, respectively.

In general, mean clinical parameters at 6 mo were higher in pts in DAS-CRP and in DAS-ESR remission compared to pts in SDAI or in A/E remission. The only exceptions were CRP, which was lowest in pts in DAS-CRP remission, and ESR, which was lowest in pts in DAS-ESR remission, reflecting the high weighing of the acute phase reactants in the DAS criteria. When comparing clinical characteristics at 6 mo between pts in SDAI and pts in A/E remission, mean CRP, ESR, Phys. Global Assess., DAS28-ESR, DAS28-CRP and SDAI score were comparable, while morning stiffness, HAQ, TJC, SJC, Pat Global Assess. were lower in pts in A/E remission. Pts in A/E remission at 6 mos consistently had the lowest HAQ over a 4 year period (as observed analysis), with mean HAQ<0.5, suggesting that pts achieving stringent remission criteria regain normal function and maintain it over 4 years.

Multivariate regression analysis showed that baseline characteristics predicting remission according to the different criteria at 6 mo did not differ greatly. Male gender and HAQ were the major prediction factors for remission.

Conclusions The results of this real-world study show that pts in DAS remission have higher disease activity than pts in SDAI or A/E remission. Although ACR/EULAR endorses both the SDAI as well as the A/E criteria, disease activity in pts in SDAI versus A/E remission was different in this real world pt population, with pts in A/E remission having lower disease activity. Stringent remission 6 mo after IFX initiation was associated with a normal functional outcome (mean HAQ<0.5) over 4 years.

  1. Felson et al. Arthritis Rheum. 2011. 63(3): 573

Disclosure of Interest None Declared

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