Background Poor prognosis of RA is associated with early and destructive disease, and a better understanding of prognostic factors such as anti-CCP that are highly predictive of future development of RA would be beneficial to initiate an aggressive therapy early after diagnosis.
Objectives To evaluate the impact of anti-CCP status on patient management and to assess associations between the anti-CCP status/levels and clinical outcome measures.
Methods A multi-center, international, prospective, observational study. Adult patients recently diagnosed with RA were included in the study. Patients were followed up during 12 months (baseline, months 3, 6, 9, 12). Socio-demographic data, medical history, concomitant anti-rheumatic medication, CRP, ESR, anti-CCP and/or RF data were collected. TJC, SJC, DAS28, HAQ-DI were assessed quarterly. At each visit, the impact of patient's serology and different outcome measures on treatment decisions were evaluated.
Results 942 patients were enrolled and 685 patients completed all visits. Mean age was 56 years, 82.4% were females. Anti-CCP were positive in 71% with mean value of 538. Medical history indicated that 75.1% of the patients had at least one concomitant pathology, the most frequent of which within the cardiovascular system (32.2%). At baseline, 51.4% were treated with conventional synthetic DMARD as monotherapy (mainly methotrexate) combined with corticosteroids (46.1%); DMARD and corticosteroid usage decreased significantly by month 12 to 32.3% and 22.3%, respectively. Biologic DMARDs were used in 3.4% of patients at baseline and in 7.4% at final visit. Each of the clinical secondary parameters decreased by final visit. Mean TJC decreased from 14.8 to 4.5 and mean SJC decreased from 9.6 to 2.2. Mean duration of morning joint stiffness decreased from 75.2 min to 23.1 min. Mean DAS28 value decreased from 6.3 to 3.6, and VAS score decreased from 65.2 to 30.5. Mean HAQ-DI total score decreased from 1.5 to 0.8. For the majority (58%) of patients, clinicians believed that anti-CCP marker was significant or of ... highest possible importance, and the importance did not change for the majority (56.6%) by the end of the study. However, erosions, multiarticular expanding, and accelerated ESR were reported to be of more importance. Physician consideration of anti-CCP status as “important” impacted their decision-making with regards to increase in DMARD dose, use of combination therapy and application of aggressive treatment. Beyond the anti-CCP status, some other attributes also influenced physicians decision making: both duration of morning stiffness and presence of rheumatoid nodules induced biological DMARD adjustment, and presence of rheumatoid nodules induced use of DMARD combination.
Conclusions Anti-CCP status is considered to be an important factor in treatment decision-making,but traditional inflammatory measures remain more influential factors. The use of anti-CCP status may allow to better predict the diagnosis and prognosis of patients with RA. Whether this or other serologic tests, will allow more rational therapeutic decision-making and influence the long-term RA outcome will be determined by further study.
Acknowledgements The design, study conduct, and financial support for the clinical trial were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.
Disclosure of Interest K. Ratnik: None declared, A. Baranauskaite Grant/research support: AbbVie, Pfizer, MSD, Roche, Speakers bureau: Abbvie, MSD, I. Iancuta Consultant for: Abbvie, MSD, Roche, Pfizer, UCB, BMS, Janssen, Speakers bureau: Abbvie, MSD, Roche Pfizer, T. Vlak Grant/research support: MSD, Roche, Abbott Laboratories, Speakers bureau: MSD, Roche, Lilly, Abbott Laboratories, G. Poόr Grant/research support: Abbott Laboratories, Abbvie, Consultant for: Abbott Laboratories, AbbVie, UCB, Pfizer, MSD, Amgen, Roche, Speakers bureau: Abbott Laboratories, R. Kuzminiene Employee of: Abbvie Pharmaceuticals
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