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AB0449 Baseline Procalcitonin (PCT) Level as A Predictive Marker for Clinical Remission (DAS28-ESR, CDAI) at 52 Weeks in Biologic NaÏVe Rheumatoid Arthritis (RA) Patients Treated by TOCILIZUMAB (TCZ); A Single Center Retrospective Study
  1. S. Tsuji1,
  2. A. Yura2,
  3. M. Katayama1,
  4. A. Watanabe1,
  5. S. Teshigawara1,
  6. M. Yoshimura1,
  7. E.K. Tanaka1,
  8. Y. Harada2,
  9. K. Kagawa3,
  10. Y. Katada2,
  11. M. Matsushita1,
  12. S. Ohshima3,
  13. J. Hashimoto1,
  14. Y. Saeki3
  1. 1Rheumatology
  2. 2Allergy and clinical immunology
  3. 3Clinical research, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan

Abstract

Background The goal in treating RA has changed from clinical remission to structural remission with the increased use of biological agents (Bio) which target the pro-inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α. PCT, a useful marker of infection, has been shown to increase in mRNA expression in peripheral blood mononuclear cells by stimulated by pro-inflammatory cytokine, IL-6 or TNF-α.

Objectives This study investigates whether the levels of following parameters (PCT, modified HAQ (mHAQ), MMP-3, RF, ESR, CRP and ACPA) at baseline (BL) of TCZ treatment can be used to predict clinical remission (DAS28-ESR, CDAI) at 52 weeks after the start of TCZ treatment.

Methods Bio naïve RA patients who can be observed at Week 52 were analyzed in this study. PCT (n=34), mHAQ (n=48), matrix metalloproteinase (MMP)-3 (n=54), RF (n=54), ESR (n=53), CRP (n=56) and ACPA (n=52) were assessed at BL. The patients were divided into 2 groups, based on DAS28-ESR remission (DAS28-ESR<2.6) at Week 52. For each variable where there was a significant difference between the remission and non-remission groups, receiver operating characteristic (ROC) analysis was performed and cut-off values (COV) were found. For each of those variables, 2 groups were formed by dividing the Bio naïve RA at the COV: the under COV (U) group and over COV (O) group, and the Week 52 clinical remission (DAS28-ESR, CDAI) rate in each group were analyzed.

Results The variables with a significant difference between the remission and non-remission groups were PCT (p=0.001), mHAQ (p=0.014), RF (p=0.003), ESR (p=0.001) and CRP (p=0.041). The COVs were 0.027 ng/ml for PCT, 100U/ml for RF, 0.38 for mHAQ, 18 mm/hr for ESR, 1.96 mg/dl for CRP. For each variable, the DAS28-ESR remission rate in U group (PCT: 100%, mHAQ: 70.8%, RF: 77.8%, ESR: 87.5% and CRP: 64.3%) was significantly higher than in O group. Additionally, the CDAI remission rate in U group (PCT: 50.0% (p=0.040) and RF: 32.1% (p=0.026)) was significantly higher than in O group, but not others. For PCT at BL, DAS28-ESR or CDAI were no different between the U group and O group and no correlation with DAS28-ESR or CDAI were observed. BL DAS28-ESR was significantly lower in U groups for all other variables. Furthermore, BL PCT had correlation with DAS28-ESR and CDAI at Week 52.

Conclusions BL PCT level is a useful predictive marker for clinical remission (DAS28-ESR, CDAI) at week 52 in Bio naïve RA treated by TCZ. Moreover, unlike other variables, it is not affected by the BL disease activity level.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2437

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