Objectives To assess the efficacy of non-biological disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients (pts) depending on rheumatoid factor (RF) and/or antibodies against cyclic citrullinated peptides (aCCP) presence.
Methods The analysis of DMARDs effectiveness in 104 RA pts (84.6% - female) at mean age 52.9±0.96 years, with mean disease duration 22.7±4.13 months was performed. Early RA (up to 2 years) in 75 individuals (72.1%) was observed. 62.7% of pts were sero+ by RF (Humatex, Germany), 75.8% - by aCCP (IBL-Hamburg, Germany). Four groups of pts were formed: three groups of sero+ pts - aCCP+RF+ (n=49), aCCP+RF- (n=15), aCCP-RF+ (n=10) and group of sero- (aCCP-RF-) pts (n=30). All pts were receiving one of the variants of DMARDs therapy for no less than 2 years: methotrexate (MTX) in dose 7.5-20 mg/week, leflunomide (LF) in dose 10-20 mg/day, sulfasalazine (SS) 2 g/day or DMARDs combination (CT). Effectiveness outcomes were evaluated after 2 yrs of treatment by ΔDAS28, ΔSHS, frequency of achievement of clinical remission (CR) (DAS28<2.6), radiological (X-ray) remission (RR) (ΔSHS≤0.5), clinical and X-ray remission (CRR) (DAS28<2.6, ΔSHS≤0.5), clinical and X-ray disease control (CRC) (DAS28<3.2, ΔSHS≤0.5). Before study, sero- and sero+ groups of pts were comparable by all demographic, clinical and X-ray characteristics, frequency of DMARD prescribed (MTX (53.3 and 52.7%), LF (13.3 and 16.2%), SS (6.7 and 8.1%), CT (26.7 and 23.0%)) with the exception of the age of pts (sero+ 51.8±1.2, sero- 55.6±1.4 yrs, p<0.05).
Results After 2 years of treatment ΔDAS28 in sero- pts was almost twice better compared with sero+ groups in sum (2.93±0.34 vs 1.65±0.32, p<0.05), as well as with subgroups of aCCP+ pts: aCCP+RF+ (1.69±0.4, p<0.05) and aCCP+RF- (1.08±0.45, p<0.001), but comparable with aCCP-RF+ pts (2.61±0.53 p>0.05). CR was achieved in 56.6% of sero- pts which is three times more often than in sero+ pts (18.9%, p<0.001) and also then in subgroups of aCCP+ pts: aCCP+RF+ (18.4%, p<0.001), aCCP+RF- (0%, p<0.001). CR was also achieved in 40% of aCCP-RF+ pts (p>0.05 vs aCCP-RF-). After 2 years ΔSHS in sero- pts was only 1.35±0.5, while in sero+ pts X-ray changes were 9 times more significant (p<0.001), mainly due to aCCP+ pts: aCCP+RF+ (12.1±2.45, p<0.001 vs aCCP-RF-), aCCP+RF- (17.1±1.36, p<0.001). But in aCCP-RF+ pts ΔSHS was comparable to sero- pts (4.33±3.28, p>0.05 vs aCCP-RF-, p<0.05 vs aCCP+RF-). Rapid RA progression (≥4 erosions/year) only in sero+ (namely aCCP+) pts was observed. Frequency of RR achievement was highest in subgroup of sero+ pts without aCCP (70%) and sero- pts (60%), which is 2-3 times more than in all sero+ pts (25.7%), in particular aCCP+, regardless of RF presence. After 2 years 33.3% sero- pts have achieved CRR and CRC which is by 55% more compared with sero+ pts in general and by 63.3% compared with aCCP+RF+ pts in particular. The difference between sero- and aCCP-RF+ pts was not significant.
Conclusions 1.Clinical and X-ray response to non-biological DMARDs in sero- pts is better then in sero+ pts, especially compared to the subgroup of aCCP+ pts. 2.The results of treatment of RF+ pts without aCCP is comparable with sero- pts and significantly better then in aCCP+ pts regardless of RF presence, approaching aCCP-RF+ subgroup to sero- pts.
Disclosure of Interest None declared