Ab0260 treatment With Biotechnological Drugs According to Pre-Defined Selection Criteria in Patients With Rheumatoid Arthritis: Preliminary Results of a Single Cohort

Abstract

BackgroundCurrent recommendations on the treatment of Rheumatoid Arthritis (RA) are based on a treat to target approach, nevertheless which biologic drug should be used in an unresponsive patient is not clarified (1). Such a strategy is essentially justified by the fact that no biotechnological drug has proved to be superior to any other (2).Recent studies have reported some disease or patient features that are associated with a greater or lesser likelihood of response (3). Nevertheless, an adapted therapy to the single patient and based on physiopathological mechanisms has not been acquired yet.ObjectivesAim of this study was to evaluate if the choice of a tailored therapy, based on patient and disease features, would be an effective strategy.MethodsFrom April 1st 2017, at our Department of Rheumatology of the University of Campania, each patient with RA has been characterized, at enrolment, for demographic and disease features, and started a biological Disease-modifying antirheumatic drug based on an established algorithm (Figure 1). Attainment of the targeted end point i.e. remission (R) as assessed by Simplified Disease Activity Index (SDAI) <3.3 or at least low disease activity (LDA), SDAI<11, has been evaluated at 3, 6 and 12 months.Figure 1ResultsForty-nine patients were admitted to our centre from April 1st2017 to December 31st2018. Out of them, 36 patients have been followed up at least for 3 months and were included in the study (algorithm+ patients). Out of them, 26 (72.2%) reached 6 months of treatment, while 16 (44.4%) 12 months of treatment. Among the 26 patients evaluated at 6 months, 23(88.5%) achieved the targeted end point. At 12 months, 16/16 patients (100%) preserved a status of remission or at least low disease activity. We compared our results to those registered, from January 2015 to September 2016, in a RA cohort of 79 patients (RA general cohort). We found a significant difference in regard to attainment of the target at 6 months (23/26 patients, 88.5% algorithm+ vs 45/67 patients, 67.2% RA general cohort; p=0.04) and at 12 months (16/16 patients, 100% algorithm+ vs 40/57 patients, 70.2% RA general cohort; p=0.01) (Table 1). Notably, 32 out of the 79 patients had undergone a biological drug which didn’t follow the predefined algorithm. These patients (algorithm- patients) presented a further lower incidence of response with regard to those enrolled according to the algorithm: 22/32 patients (68.7%) at 3 months; p=0.4; 17/29 (58.6%) at 6 months; p=0.001; 17/24 (70.8%) at 12 months; p=0.03).ConclusionThe choice of a personalized approach toward treatment of RA might be an effective strategy to achieve the targeted end point of remission or at least low disease activity in every patient.References[1] Smolen JS et al. Ann Rheum Dis 2017;76:960–77[2] Pierreisnard A et al. Joint Bone Spine. 2013;80:386-92.[3] Daïen CI et al. Mediators of Inflammation 2014;2014:386148Table 1 Comparison of percentage of response between Algorithm + patients (n.36) and RA general cohort (n.79) Algorithm+ patients ...