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.


Treatment with TNF-Inhibitors Reduces Radiographic Joint Destruction in Rheumatoid Arthritis Patients Treated in Clinical Practice.

Ornbjerg1,  Lykke M., Ostergaard1,  Mikkel, Boyesen12,  Pernille, Thormann1,  Anja, Tarp6,  Ulrik, Bohme13,  Wolfgang, Dencker13,  Ditte

DANBIO Registry and Depts. of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Denmark
Dept. of Rheumatology, Copenhagen University Hospital at Rigshospitalet, Denmark
Dept. of Rheumatology, Copenhagen University Hospital at Slagelse, Denmark
Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
Dept. of Rheumatology, Hospital of South West Jutland at Esbjerg, Denmark
Dept. of Rheumatology, King Christian Xth Hospital, Gråsten, Denmark
Dept. of Rheumatology, Odense University Hospital, Denmark
Depts. of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Denmark
Dept. of Internal Medicine and Rheumatology, Gentofte University Hospital, Denmark
Dept. of Internal Medicine, Copenhagen University Hospital at Holbæk, Denmark
Dept. of Internal Medicine, Hospital Lillebaelt at Vejle, Denmark
Dept. of Rheumatology, århus University Hospital at ålborg, Denmark
Dept. of Rheumatology, århus University Hospital, Denmark
Dept. of Rheumatology, Copenhagen University Hospital at Frederiksberg, Denmark
Dept. of Rheumatology, Copenhagen University Hospital at Hørsholm, Denmark
Dept. of Rheumatology, Copenhagen University Hospital at Næstved, Denmark

Background:

Real-life studies concerning the impact of tumour necrosis factor inhibitor (TNF-I) treatment on radiographic progression in rheumatoid arthritis (RA) patients are few.

Objectives:

To compare radiographic progression (delta total Sharp (dTSS); erosion (dES); and joint space narrowing (dJSN) scores) during treatment with disease-modifying antirheumatic drugs (DMARDs) and during subsequent treatment with TNF-I in RA patients in clinical practice.

Methods:

Conventional radiographs (CR) of hands and wrists were obtained ~2 years before start of TNF-I (time-point A), at the start of TNF-I (B) and ~2 years after start of TNF-I (C). Clinical data from the DANBIO registry and the patientfiles was collected for the patients with CRs. The CRs were scored blinded to chronology according to the van der Heijde modified Sharp score. Annual radiographic progression rates during DMARD (delta A-B) and TNF-I (delta B-C) treatments were calculated.

Results:

522 RA patients (76% women, 80% rheumatoid factor positive, 65% anti-CCP positive, 27% current smokers, age 54 (21–86) years (median (range)); disease duration 5 (0–67) years) had complete A-B-C series. At time-point A, 28-joint disease activity score (DAS28) was 4.4 (1.4) (mean (SD)) and patients received the following treatments: methotrexate (MTX) (45%), sulphasalazine (22%), hydroxychlorochine (12%), leflunomide (5%), other DMARDs (6%) or no DMARDs (10%). At time-point B, DAS28 was 5.0 (1.1) and treatment with infliximab (61%), etanercept (15%), or adalimumab (24%), was started (combination with MTX (78%), combination with other DMARDs (10%), monotherapy (12%)). At time-point C, 60% were on the initial TNF-I, 29% had switched to another TNF-I and 11% withdrawn from TNF-I. Mean DAS28 was 3.1(1.2). The duration of Period A-B was median 735(interquartile range 484–1002) days and of period B-C 562 (405–766) days. Radiographic data are shown in Table 1. The progression rate (deltaTSS) during TNF-I treatment was reduced by 61% compared to DMARD.

Table. Radiographic progression during treatment with DMARDs and subsequent treatment with TNF-I in RA patients in clinical practice.

 A DMARDB TNF-I startC 2 yr follow-upDelta A-B/yrDelta B-C/yrP value
TSS mean(SD)21.0 (29.8)25.7 (32.0)27.0 (32.8)2.1 (3.8)0.67 (2.3)<0.0001 (1)
TSS median (IQR)7 (1–31)13 (2–40)14 (3–42)0.73 (0–2.9)0 (0–0.89)<0.0001 (2)
ES mean(SD)13.1 (19.9)15.5 (21.3)16.2 (21.7)1.04 (2.0)0.36 (1.4)<0.0001 (1)
ES median (IQR)4 (0–18)6 (1–23)7 (1–24)0.2 (0–1.4)0 (0–0)<0.0001 (2)
JSN mean(SD)7.8 (11.5)10.2 (12.7)10.8 (13.2)1 (2.6)0.31 (1.2)<0.0001 (1)
JSN median (IQR)2 (0–12)5 (0–16)6 (0–17)0 (0–1.4)0 (0–0)<0.0001 (2)
Progressing patients (%)   5931<0.0001 (3)
(1) Paired T-test (2) Paired Wilcoxon-test (3) Chi-square test A, 2 years before TNF-I treatment start; B, TNF-I treatment start; C, 2 years after TNF-I treatment start; TSS, total van der Heijde Sharp score; ES, erosion score; JSN, joint space narrowing; SD, standard deviation; IQR, inter quartile range; Delta A-B/yr, annual progression rate time A to B; Delta B-C/yr, annual progression rate time B to C.

Conclusion:

Real-life data from a large nationwide observational cohort showed that use of TNF inhibitors in RA patients treated for ~2 years in routine care significantly reduces the rate of joint damage progression when compared to the previous ~2 years on conventional treatment.

To cite this abstract, please use the following information:
Ornbjerg, Lykke M., Ostergaard, Mikkel, Boyesen, Pernille, Thormann, Anja, Tarp, Ulrik, Bohme, Wolfgang, et al; Treatment with TNF-Inhibitors Reduces Radiographic Joint Destruction in Rheumatoid Arthritis Patients Treated in Clinical Practice. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1841
DOI: 10.1002/art.29606

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