FRI0134 Is there any difference in ra patients for methotrexate use vs. leflunomide use as a concomitant treatment with biological and targeted synthetic dmards in turkbio registry?

Abstract

BackgroundTURKBIO registry is the Turkish version of Danish DANBIO rheumatologic database which has been established in 2011. Demographics and previous or current treatment with conventional (csDMARD) and targeted synthetic (tsDMARD), and biological DMARDs (bDMARDs) were collected.ObjectivesWe aimed to investigate the efficacy and safety status of methotrexate (MTX) vs. leflunomide (LEF) use as a concomitant treatment with bDMARDs and tsDMARD in this registry.MethodsFrequencies of achievement of remission or remission +low disease activity (LDA) at the 6th month of bDMARD or tsDMARD treatment were compared between patients who were on these medications with MTX vs. LEF as a concomitant treatment. Drug survival and switch rates of bDMARDs and tsDMARD treatments either with MTX or LEF were compared. The adverse effects with MTX and LEF concomitant use were evaluated as well.ResultsThe study included 725 bDMARD or tsDMARD receiving RA patients from 8 participating centres of the TURKBIO registry. Of these patients, 462 (63.7%) were receiving concomitant MTX and 263 (36.3%) LEF. Demographic findings are given in the table 1. Achievement of remission and remission +LDA at the 6th month of bDMARD or tsDMARD initiation was similar in concomitant MTX vs LEF groups (51.4% vs. 53%, p=0.683). When each bDMARD and tsDMARD was evaluated separately, achievement of remission were again similar in MTX and LEF concomitant users (TNFi: 53% vs. 54%; ABA: 50% vs. 59%; RTX: 53% vs. 61%; TCZ: 42% vs. 35%; p>0.05 for all). For TOFA, although remission +LDA rate was numerically higher in MTX concomitant group than LEF group (42% vs. 21%), the difference was not statistically significant due to the smaller sample size of TOFA (n=33). The results were similar for all DMARD groups when remission was evaluated alone. Drug survival (17±12 vs. 16±11 months, p>0.05) and drug discontinuation (42,2 vs 38, p>0.05) rates of bDMARDs or tsDMARD were also not different in MTX vs. LEF concomitant users. Adverse effects rate (19.5% vs 20.5%, p>0.05) were similar between MTX vs. LEF concomitant users as well.Abstract FRI0134 – Table 1Demographic findings of patients.ConclusionsAchievement of remission or remission +LDA was not different with the concomitant use of MTX vs. LEF with any bDMARD or tsDMARD treatment in RA patients with a similar safety profile. LEF might be an alternative as a concomitant DMARD in MTX-intolerant RA patients initiating bDMARDs or tsDMARD.Disclosure of InterestNone declared

Most Appropriate Conventional Disease‐Modifying Antirheumatic Drug to Combine With Different Advanced Therapies in Rheumatoid Arthritis: A Systematic Literature Review With Meta‐Analysis

“…No differences were found in the mean delta DAS28 score (2.17 ± 1.43 versus 2.23 ± 1.38) and for DAS28 remission (<2.6: 11 of 26 (42%) versus 24 of 55 (44%) for LEF versus MTX). Inanc et al observed a similar rate of remission between TCZ with LEF and with MTX (42% versus 35%, P > 0.05) in the TURKBIO registry at 6 months (32).…”

“…In the TURKBIO registry, the level of remission and low disease activity rate at 6 months were lower with LEF than with MTX (21% versus 42%) combined with tofacitinib, but the difference was not statistically significant because of the small sample size of patients with tofacitinib in this registry (n = 33). No baseline characteristics were available to compare the 2 groups (32). In the RA‐BUILD RCT evaluating baricitinib (4 mg per day), ACR20 at 6 months was 53% (23 of 43) versus 67% (76 of 114) with non‐MTX csDMARDs and MTX.…”