Objectives To investigate the predictive value of synovitis detected by Doppler ultrasound (DUS) in relation to successful tapering of BT in RA patients in sustained clinical remission.
Methods Seventy-seven RA patients (52 women, 25 men) treated with BT were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were as follows: 1) being in treatment with stable doses of BT and synthetic disease modifying antirheumatic drugs (DMARDs) in the previous 12 months; 2) being in sustained clinical remission judged by their usual consultant rheumatologist and according to Disease Activity Score in 28 joints (DAS28) or Simplified Disease Activity Index (SDAI) criteria in the previous 12 months; 3) being in treatment with ≤5 mg/day of prednisone in the previous 6 months; 4) having needed neither nonsteroidal anti-inflammatory drugs (NSAIDs) for more than 1 week nor local corticosteroid injections in the previous 6 months. BT was tapered at baseline according to an agreed strategy implemented in clinical practice (i.e. increasing the interval between doses for subcutaneous BT and reducing the dose for intravenous BT). Patients underwent clinical and laboratory assessment every 3 months. DUS investigation of 42 joints for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler (PD) signal (i.e. Doppler synovitis) was performed at baseline by a rheumatologist blinded to therapy, clinical and laboratory data. A global index for B-mode synovitis (BSI) and a global index for Doppler synovitis (DSI) were calculated. Hand and foot radiographs were obtained at baseline and at 12-month followup. BT tapering failure was assessed at 6 and 12 months. BT tapering failure was defined as an increase in BT doses by their usual consultant rheumatologist and/or the presence of clinical disease activity according to both DAS28 and SDAI criteria.
Results Twenty-three (29.9%) patients were treated with adalimumab, 21 (27.3%) with etanercept, 18 (23.4%) with infliximab, 7 (9.1%) with tocilizumab, 6 (7.8%) with abatacept, and 2 (2.6%) with golimumab. Thirty-five (45.5%) patients presented tapering failure at 12 months, 23 (29.9%) of them before 6 months of BT tapering. Longer duration of RA (p=0.009), higher number of previous synthetic DMARDs (p=0.003), higher DAS28 at baseline (p=0.011), higher SDAI at baseline (p=0.003), higher DSI at baseline (p<0.0005) and DSI >0 at baseline (p<0.0005) were associated with BT tapering failure at 12 months. Longer duration of RA (p=0.020), higher number of synthetic DMARDs (p=0.049), higher DAS28 at baseline (p=0.002), higher SDAI at baseline (p=0.003), higher DSI at baseline (p<0.0005) and DSI >0 at baseline (p<0.0005) were associated with TB tapering failure at 6 months. No patient showed radiographic progression.
Conclusions Our results suggested that the presence and grade of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical remission.
Disclosure of Interest : E. Naredo Grant/research support: UCB and MSD, Consultant for: Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, General Electric Healthcare, and Esaote, L. Valor: None declared, I. De la Torre: None declared, M. Montoro: None declared, N. Bello: None declared, J. Martínez-Barrio: None declared, L. Martínez-Estupiñán: None declared, J. C. Nieto: None declared, J. G. Ovalles-Bonilla: None declared, D. Hernández: None declared, C. M. González: None declared, J. Lόpez-Longo: None declared, I. Monteagudo Consultant for: Abbvie, Roche Farma, Bristol-Myers Squibb, Pfizer, UCB, L. Carreño: None declared