FRI0124 Prevention of extensive bone marrow oedema and consequent rapid radiographic progression by short term usage of biologics in drards resistant patients with early destructive rheumatoid arthritis

Abstract

ObjectivesTo investigate possible preventive effect of radiographic joint damage, especially RRP by short term treatment with biologics in non-biological disease-modifying ant-rheumatic drugs(non-bio DMARDs) resistant early RA (Clinical registration number; UMIN-CTR 000013614).MethodsFifty early RA patients with extensive BE by hand MRI test despite treatment with non-bio DMARDs were recruited. Among these, 44 patients were diagnosed as RRP. Twenty three patients (male 5, female 18) were treated with combination of non-bio DMARD and biologic DMARDs (Bio group) and 26 patients were treated with enhanced DMARDs therapy using MTX with or without other DMARDs (enhanced DMARDs group). Baseline demographics of both groups were not significantly different (Data not shown). In the Bio group, the following biologics were added: Adalimumab (13 cases), Tocilizumab (3 cases), Abatacept (3 cases), Infliximab (2 cases), Certolizumab (1 case), Golimumab (1 case). In enhanced DMARDs group, mean MTX dose was increased from 7.3 mg/w to 11.3 mg/w or other DMARDs were added. Bone destruction was determined before and 3 or 6 months after treatment by modified total Sharp scoring (mTSS) using by conventional radiography, and expressed as yearly progression of mTSS (ΔmTSS/y). BE score was measured by RAMRIS method using T1 or STIR image of hand MRI (HITACHI, Elis, 0.5T).ResultsSignificant reduction in DAS28-ESR values after 3 or 6 months treatment were observed: from 4.2 to 3.3(p=0.0004) in the enhanced DMARDs group, and 4.37 to 3.0(p<0.0001) in the Bio groups. Similarly, improvement of BE: 7 out of 26 (26.9%) and 14 out of 23 patients (60.9%), mean ΔmTSS/y: 5.8 and 2.4, incidence of RRP: 9 (34.6%) and 9 (34.6%), and structural remission: 5 (21.7%) and 16 patients (69.6%), in the enhanced DRAERDs and the Bio group, respectively. Accordingly, improvement of BE and incidence of structural remission was higher, whereas mean ΔmTSS/y value was significantly lower (p<0.05) in the Bio group compared to in the enhanced DMARDs group (table 1, figure 1).Abstract FRI0124 – Table 1Comparison between the Enhanced DMARDs group and the Bio groupEnhanced DMARDs group (n=23)Bio group (n=26)P ΔmTSS/y5.82.40.0142*% RRP34.6% (9/26)21.7% (5/23)n.s% Structural remission (%)34.6% (9/26)69.6% (16/23)0.0146*% BE improvement26.9% (7/26)60.9% (14/23)0.0166**: significantAbstract FRI0124 – Figure 1Radiographic dataConclusionsResults of this study indicated that short term (3 or 6 months) treatment with biologics is effective in the reducing BE, and consequently prevent further progression of the disease into RRP status in 80% of early destructive RA despite extensive DMARDs therapy. The effect of withdrawal of biologics in RA improving BE are currently under investigation (figure 1). We consider that a short-term treatment with biologics for early RA patients, who are resistant to DMARDs and at high risk to transit to RRP, will be an effective and economical treatment strategy.Disclosure of InterestNone declared