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AB0765 Treat to Target Strategy in Active Early Psoriatic Arthritis (Preliminary Results Of An Ongoing Remarca Study)
  1. T.V. Korotaeva,
  2. E. Loginova,
  3. A. Glazkov,
  4. D. Karateev,
  5. E. Nasonov
  1. Nasonova Research Institute of Reumatology, Moscow, Russian Federation

Abstract

Background Treat to target (T2T) strategy for spondyloarthritis, including psoriatic arthritis (PsA) has been recently proposed. The main goal of this strategy is to reach remission or low/minimal disease activity (MDA).

Objectives to investigate T2T strategy with methotrexate (MTX) subcutaneous (s/c) and anti-TNF-therapy (adalimumab) in active early peripheral psoriatic arthritis (EPsA).

Methods 23 (M/F – 8/15) treatment-naïve patients (pts) with active peripheral EPsA, according to the CASPAR criteria, mean age 39.1±10.6 yrs., PsA duration 7 [4; 24] mo., disease activity index (DAS) 3.97 [3.07; 4.67], DAS28 4.33 [3.68; 4.73], Psoriasis duration 36 [12; 84] mo., PASI 6 [3.1;9.7], BSA (%) 1 [0.5; 3.65], HAQ 0.75 [0.63; 1.25], C-reactive protein (C-RP, mg/l) 15 [8.6;25.1], ESR (mm/h) 15 [8.6;25.1] were included. At the baseline and every other 3 mo. of therapy all pts underwent standard clinical examination: Tender Joint count (TJC78/28), Swollen Joint Count (SJC76/28), patient pain VAS, patient/physician's global disease activity VAS, PASI, BSA, HAQ, DAS, DAS28, C-RP (mg/l), ESR (mm/h). Response to the treatment was defined as percentage of pts who met remission (DAS<1.6 or DAS28<2.6), low disease activity (LDA) (1.6≤DAS<2.4 or 2.6≤DAS28<3.2), MDA, ACR20/50/70. The dose of MTX (s/c) was escalated by 5 mg eow from 10 mg/wk to 20 mg/wk. If pts do not achieve the MDA/LDA or remission after 3 mo. MTX mono-therapy (MoT) combination therapy (CoT) MT+Adalimumab (ADA) 40 mg s/c eow will start. Mean ± SD, Me [Q25; Q75], χ2-test, Friedman ANOVA were performed. All p<0.05 were considered to indicate statistical significance.

Results Significant changes in baseline data up to 6 mo. of therapy are now avalible.

Table 1

After 3 mo. of therapy MoT MTX remission by DAS/DAS28 was seen in 13%/22.7%, LDA by DAS/DAS28 in 21.7%/27.3% and MDA in 26.1% of pts. ACR 20/50/70 was achieved 65.2%/26.15/8.7% of pts accordingly. After 3 mo. 4 pts had high disease activity and were treated by CoT MT+ADA 40 mg s/c eow, 19 pts were continued MTX MoT. After 6 mo. remission by DAS/DAS28 was seen in 34.8%/39.1%, LDA by DAS/DAS28 in 26.1%/39.1% and MDA in 47.8% of pts. ACR 20/50/70 was achieved 73.9%/60.9%/47.8% of pts accordingly. After 6 mo. of MTX MoT (n=19) remission by DAS/DAS28 was seen in 36.8%/36.8%, LDA in 15.8%/36.8%, MDA in 47.4% of pts. ACR 20/50/70 was achieved 68.4%/52.6/42.1% of pts. MTX+ADA CoT (n=4) ACR 20/50/70 and MDA was achieved 100%/100%/75% and 50% of pts accordingly.

Conclusions T2T strategy - active treatment of EpsA pts with predominantly MoT MTX s/c for 6 mo. show MDA in a half of pts (47.8%), remission by DAS in a third (34.8%) and ACR20/50/70 achieved 73.9%/60.9%/47.8% of pts accordingly.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.3151

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