gms | German Medical Science

Introduction: Patients with RA and longer disease duration generally do not respond as well to treatment with DMARDs as patients with a shorter duration of disease. Earlier use of biologic DMARDs can improve disease control [1], [2]. The AVERT trial provides the opportunity to examine outcomes in patients with varying degrees of early disease duration in which the definition for disease duration is well defined across groups.

Methods: Patients with early active RA (clinical synovitis in ≥2 joints for ≥8 weeks, persistent symptoms for ≤2 years and DAS28 [CRP] ≥3.2), and who were anti-cyclic citrullinated peptide-2 positive, were randomized to SC abatacept (ABA) 125 mg/week + MTX, SC ABA 125 mg/week alone or MTX alone for 12 months. All RA treatment was removed after 12 months in patients with DAS28 (CRP) <3.2 [3]. In this post hoc analysis, proportions of patients achieving protocol-defined remission (DAS28 [CRP] <2.6) or improvement in HAQ-DI (≥0.3 units from baseline) were assessed by ≤3 months’, >3 to ≤6 months’ or >6 months’ disease duration (defined as the duration of persistent symptoms at baseline) and treatment group. Adjusted mean changes from baseline in HAQ-DI were also evaluated by disease duration.

Results: Patients were randomized and treated with ABA+MTX (n=119) or MTX (n=116): 36 and 48 with ≤3 months’; 34 and 29 with >3 to ≤6 months’; 49 and 39 with >6 months’ disease duration, respectively. No systematic differences were seen in baseline demographics and clinical characteristics for patients grouped by disease duration. Irrespective of baseline disease duration, a higher proportion of ABA+MTX-treated patients achieved Month 12 and sustained (Month 18) remission, compared with MTX alone. A higher proportion of ABA+MTX-treated patients with disease duration ≤3 months maintained remission following all treatment withdrawal compared with longer disease durations and MTX alone (Figure 1 [Fig. 1]). ABA+MTX-treated patients with ≤3 months’ disease duration also had the fastest onset of response (Figure 1 [Fig. 1]). Results for HAQ-DI were similar to the overall population, regardless of baseline disease duration.

Conclusion: Disease duration of ≤3 months was associated with faster onset of clinical response and the ability to achieve higher rates of drug-free remission following treatment with abatacept+MTX in AVERT.

Note: This abstract was first presented at the EULAR Congress, 10–13 June 2015, Rome, Italy (FRI0152) and published in the corresponding supplement of Ann Rheum Dis.