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• W2552543334 abstract "Background International guidelines for treatment-to-target in rheumatoid arthritis (RA) recommend methotrexate (MTX) as first line therapy because of its favorable benefit/risk ratio and long-term safety. However, about 50% of patients fail to achieve remission and require other treatment. Identification and application of predictors of inadequate response to MTX may improve clinical outcome by enabling timely step-up treatment in those who need it. Objectives To evaluate the added predictive value of protein biomarkers compared to use of clinical variables alone, to identify early RA patients failing a MTX step-up strategy, including hydroxychloroquine (HCQ). Methods In the treat-to-target U-ACT-EARLY trial, 108 DMARD-naive RA patients initiated MTX step-up therapy (10 mg to 30 mg or maximum tolerable dose) until remission (DAS28 Results Within 1 year, 56 (52%) of the 108 patients failed the strategy for various reasons: adverse events (n=4), added TCZ according to treatment protocol (n=42), withdrawal from study because of inefficacy (n=10). Multiple logistic regression identified baseline DAS28, current smoking and alcohol consumption as clinical predictors ( model 1 , AUC-ROC 0.75, 95%>CI 0.66–0.84) and in addition MCP1, IL6, IL33, sCD14 and PD1 ( model 2 , AUC-ROC 0.87, 95%>CI 0.80–0.94) as significant protein biomarkers (Table 1). The LLR test showed a better fit of model 2 (59.83, p 80% as cut off, model 1 correctly predicted 24/51 patients not failing the strategy and model 2 predicted 15 (29% improvement) extra patients not failing the strategy (Table 2). In those failing the strategy, 50/56 patients were correctly predicted by model 1 and 4 (-7%) patients less was correctly predicted by model 2 . Conclusions Adding protein biomarkers to clinical predictors increases the predictive accuracy of identifying patients at baseline who will need other treatment after initiating a MTX step-up strategy. These findings could contribute too more personalized treatment in early RA patients to optimize long-term outcomes. Disclosure of Interest X. Teitsma: None declared, J. Jacobs: None declared, P. Welsing: None declared, T. Woodworth Employee of: Roche, A. Petho-Schramm Employee of: Roche, M. Borm Employee of: Roche, C. Bernasconi Employee of: Roche, J. van Laar Consultant for: received fees from MSD, Pfizer, Roche, Eli Lilly and BMS, J. Bijlsma Grant/research support from: received research grants (to his department) from AbbVie, BMS, Crescendo, MSD, Mundipharma, Pfizer, Roche, Sun and UCB, Consultant for: received consulting fees from AbbVie, BMS, Crescendo, MSD, Mundipharma, Pfizer, Roche, Sun and UCB, F. Lafeber: None declared" @default.
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• W2552543334 date "2016-06-01" @default.
• W2552543334 modified "2023-09-23" @default.
• W2552543334 title "FRI0040 Protein Biomarkers Improves The Prediction of Clinical Response To Methotrexate Step-Up Strategy in Early RA Patients" @default.
• W2552543334 doi "https://doi.org/10.1136/annrheumdis-2016-eular.2253" @default.
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