Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Change in CRP at 12 Weeks Predicts the Risk of Rapid Radiographic Progression at 2 Years in Methotrexate-Treated Patients with Early Rheumatoid Arthritis.
Haraoui4, Boulos, Emery3, Paul, Mozaffarian1, Neelufar, Guerette2, Benoit, Kupper2, Hartmut, Patra2, Kaushik, Keystone5, Ed C.
In patients with rheumatoid arthritis (RA), radiographic progression is an important contributor to long-term disability. Hence, identifying patients at risk of rapid radiographic progression (RRP) early in the course of disease is an important goal of medical management, as it affects therapeutic decision-making.
To determine whether change in CRP after 12 weeks of treatment can indicate risk of RRP in patients with early RA.
We examined data from methotrexate (MTX)-naïve patients with early RA in the PREMIER study, a 104-week, phase III, placebo-controlled trial in which patients were randomized 1:1:1 to: weekly MTX, adalimumab (ADA) 40 mg every other week, or ADA + MTX. This post hoc analysis evaluated patients from the intention to treat population who had CRP measures at baseline and at week 12, as well as radiographs at baseline and week 104. RRP was defined as an increase of >3 units/year in the modified Total Sharp Score (mTSS). Using week 12 data, quartiles (Qs) of CRP absolute values and percent change from baseline (%DCRP) were used to assess relationships with RRP following 2 years of treatment.
Overall, RRP was significantly more likely to occur among patients treated with MTX monotherapy (33.5%) than among patients treated with ADA + MTX (6.7%). In the MTX-treated population, there was an association between increasing Qs of %DCRP (less improvement) and RRP prevalence (Table); however, this association was absent in the ADA + MTX population, where the risk of RRP was universally low. Specifically, MTX-treated patients who fell into the top Q (least improvement) of %DCRP at week 12 demonstrated 48.5% RRP; ADA + MTX-treated patients in the same Q of %DCRP displayed only 6.9% RRP. In both treatment groups, lower CRP improvement at week 12 was observed in the majority of patients ultimately identified with RRP at year 2; 84% of the MTX-treated RRP patients and 54% of the ADA + MTX-treated RRP patients exhibited CRP improvement <=80% after 12 weeks of treatment. Interestingly, increasing Qs of CRP at 12 weeks produced comparable results to those from the %DCRP.
Table. Association of Quartiles (Qs) of %DCRP From Baseline to 12 Weeks With % Rapid Radiographic Progression (RRP) From Baseline to 2 Years
|%DCRP, Qs||MTX (N = 169)||ADA + MTX (N = 201)|
|n/N (%) of RRP||n/N (%) of RRP|
|Min-Q1: -98.61-<-80.34||9/34 (26.5)||6/89 (6.7)|
|Q1-Q2: -80.34-<-61.28||12/43 (27.9)||3/58 (5.2)|
|Q2-Q3: -61.28-<-16.67||19/59 (32.2)||2/25 (8.0)|
|Q3-Max: -16.67-661.36||16/33 (48.5)||2/29 (6.9)|
CRP changes from baseline to 12 weeks or absolute CRP levels at 12 weeks were associated with the prevalence of RRP. Of note, association of CRP with poor radiographic prognosis applied mainly to patients treated with MTX monotherapy, as RRP rates were low in patients treated with ADA + MTX and CRP changes were not correlative with frequency of RRP during combination therapy. Based on these data, changes in CRP or CRP levels at 12 weeks appear to be useful tools for early identification of MTX-treated patients who will fail to achieve long-term disease control, as evidenced by significant radiographic damage.
To cite this abstract, please use the following information:
Haraoui, Boulos, Emery, Paul, Mozaffarian, Neelufar, Guerette, Benoit, Kupper, Hartmut, Patra, Kaushik, et al; Change in CRP at 12 Weeks Predicts the Risk of Rapid Radiographic Progression at 2 Years in Methotrexate-Treated Patients with Early Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1101