Thu0135 patient Global Assessment Levels Preclude the Majority of Rheumatoid Arthritis Patients Otherwise in Remission, From Reaching This Status: Systematic Literature Review and Meta-Analyses Including 23,297 Patients

Abstract

Background:Based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean-based remission definition for rheumatoid arthritis (RA), the main reason for near-misses (failing Boolean remission solely due to one criterion >1) is a patient global assessment (PGA) >1/10.1-3The frequency of this PGA-near-remission status has not been well established.Objectives:To synthesize the overall prevalence of ACR/EULAR Boolean-based remission and PGA-near-remission cross-sectionally in published studies, and to explore association with disease duration.Methods:We systematically searched PubMed database (from 1/jan/2011 till 15/jan/2020) for “Rheumatoid arthritis” AND Boolean [OR synonyms] AND PGA [OR synonyms], and carried out a hand search of the references of the included studies. Two reviewers independently assessed the study inclusion and extracted the data (n (%) of patients in each remission status, mean (SD) disease duration, and country/city). Studies were excluded if any of the four Boolean criterion was not considered (e.g. C-Reactive Protein not assessed), or if only patients with low disease activity or remission were selected. If different time assessments were provided, we selected the 1y follow-up, as the most common. Random effects meta-analyses of proportions with double arcsine transformation were performed (also by disease duration subgroups) using MEDCALC®. Heterogeneity was assessed byI2.Results:From 41 studies identified, 8 studies concerning 12 subsamples were analysed (n=23,297 patients; of which 22% had ≤2 years mean disease duration). The overall prevalence of Boolean remission was 12% (95%CI: 10-15%, p<0.005) compared to 19% of PGA-near-remission (15-23%, p<0.005) (Figure 1). In patients with shorter disease duration, PGA-near-remission was more prevalent (14% vs 18%), but even more so in longer disease duration (11% vs 19%).Conclusion:The overall prevalence of PGA-near-remission in patients with RA followed in clinical practice was 1/3 more prevalent than Boolean remission, a difference more pronounced in patients with established disease. Overall, over 61% of all RA patients otherwise in remission failed to satisfy the Boolean definition of remission solely due to a PGA>1. The use of PGA in the definition of treatment target exposes a substantial proportion of patients to the risk of overtreatment with immunosuppressive agents, while being deprived of the adjunctive therapy they probably need.References:[1]Studenic P. et al. Ann Rheum Dis. 2012;71:1702-5. doi: 10.1136/annrheumdis-2012-201519.[2]Veermer M. et al. Rheumatology (Oxford) 2012;51:1076-80. doi: 10.1093/rheumatology/ker425.[3]Ferreira RJO et al. Arthritis Care Res (Hoboken). 2019;71:1317-25. doi: 10.1002/acr.23866.Disclosure of Interests:Ricardo J. O. Ferreira Grant/research support from: Abbvie, Consultant of: Sanofi Genzyme, Amgen, MSD, Paid instructor for: UCB, Eduardo Santos: None declared, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis