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AB0301 Efficacy of Non-Biological Disease-Modifying Antirheumatic Drugs in Patients with Rheumatoid Arthritis Depending on the Presence of Rheumatoid Factor and/or Antibodies Against Cyclic Citrullinated Peptides
  1. O. Iaremenko,
  2. G. Mykytenko
  1. Internal Diseases at Stomatological Faculty, O.O.Bogomolets National Medical University, Kyiv, Ukraine

Abstract

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

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