The first biological choice in patients with rheumatoid arthritis: data from the Moroccan register of biotherapies

Evolution of Anti-citrullinated Protein Antibodies in Rheumatoid Arthritis Patients Under Disease-Modifying Therapy: A Prospective Cohort Study

Introduction The primary objective of our study was to describe the variation of anti-citrullinated protein antibodies (ACPA) antibody levels in patients with rheumatoid arthritis (RA) under disease-modifying therapy. The secondary objectives were to evaluate the variation of ACPA levels according to disease activity and to determine the characteristics of patients who have negative ACPA. Methods It was a prospective study including patients with ACPA-positive RA treated with disease-modifying antirheumatic drugs (DMARDs) and having a Disease Activity Score (DAS) greater than 2.6, indicating at least low disease activity or higher. A medical checkup including a clinical evaluation, an inflammatory test, and a measurement of ACPA levels using the enzyme-linked immunosorbent assay (ELISA) was performed for each patient at M0, M6, and M12. Two groups were defined: the rituximab (RTX) group, consisting of patients treated with RTX, and the no-RTX group, which included patients receiving other therapies, such as tumor necrosis factor inhibitors (TNFi) and interleukin 6 inhibitors (anti-IL6) or conventional disease-modifying antirheumatic drugs (csDMARDs). Results Ninety ACPA-positive RA patients were included. Seventy-seven (85.6%) were female and the mean age was 54.96 ± 13.13 years. The median disease duration was 11 years, and the baseline Disease Activity Score 28-C-reactive protein (DAS28-CRP) was 4.35 ± 0.99. Forty-eight (53.3%) of patients were already on RTX. The median ACPA level at baseline was 186 IU/ml (74-200), showing a significant decline over time (M0: 186 (74-200); M6: 111 (59-195); M12: 95 (45-195); p<0.001). This reduction was significant in the RTX group (ACPA M0: 191 (70-200); ACPA M6: 96 (33-195); ACPA M12: 75 (17-147); p<0.001) but not in the no-RTX group (ACPA M0: 156 (68-200); ACPA M6: 121 (70-195); ACPA M12: 175 (67-200); p=0.26). At M12, 27 (30%) patients achieved remission based on the DAS28 score. Their median ACPA level was 157 IU/ml (75-200) at baseline, which significantly decreased over time (p<0.001). When analyzing the delta ACPA, it was significantly larger in the RTX group (p<0.001). Conclusion In this real-life study, ACPA antibody levels decreased significantly in RA patients who had received RTX. This could suggest the possibility of achieving immunological remission with biotherapy, more specifically with RTX.

Predictors of Drug Retention and Survival Rate of bDMARDs in Rheumatoid Arthritis: A Four-Year Real-Life Tunisian Experience

Introduction

This study aims to investigate the efficacy and tolerance of biologic disease-modifying anti-rheumatic drug (bDMARDs) in the current management of rheumatoid arthritis (RA) by identifying the retention time and survival rate of bDMARDs.

Materials and Methods

We conducted a retrospective cohort study including Tunisian patients initiating bDMARD treatment between 2016 and 2018 whose data were collected from the National Health Insurance Fund (NHIF). The NHIF is the national office which organises and centralises patients under bDMARDs from all over the country. Retention and survival rate of bDMARDs at 48 months were analysed using Kaplan-Meier survival curves and compared using the log-rank test. Survival factor analysis was performed using Cox regression.

Results

Three hundred seventy-four patients, aged 55.5±12.5years [20-90], (87.2%women), were included. The mean duration of RA was 11.7±6.7 years [2-41]. The mean disease activity score (DAS)28 at initiation of the first bDMARD was 6.01±0.89 [5.37-6.5]. This first bDMARD induced low disease activity (LDA) in 55% of cases. Remission was observed in 28% of patients. The highest LDA and remission rates were observed with Tocilizumab (70.8% and 33.3% of cases, respectively). LDA and remission were achieved within a mean of 45 weeks [26-88] and 72 weeks [31-117] respectively. The 48-month first-line survival rate was 55.9%. Retention time was 41.7 months, 95%CI [39.47-43.91]. Presence of rheumatoid factors, co-prescription of methotrexate, and good initial therapeutic response were factors influencing better survival of bDMARDs (p<0.01). Glucocorticoid use predicted poorer survival (p<10-3). The first bDMARD was interrupted in 39% of cases. Ineffectiveness was the most common cause of treatment cessation (52.7%).

Conclusion

This real-life study of the Tunisian population allowed us to establish the factors that can influence the survival and retention rates of bDMARDs.

Prevalence of latent tuberculosis before biotherapy initiation in rheumatoid arthritis and spondyloarthritis: data from the Moroccan biotherapy registry

Before the initiation of biotherapy in the treatment of rheumatic diseases, it is highly recommended for the patients to be screened for latent tuberculosis infection (LTBI). The objective of this study is to identify the prevalence of LTBI among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) before the initiation of biologic therapy in the Moroccan biotherapy registry (RBSMR). A cross sectional study was conducted using the baseline data of the Moroccan biotherapy registry. Tuberculin skin test or IGRA test or both tests were done before starting anti-TNF treatment for screening LTBI. The comparisons between positive and negative LTBI patients according to rheumatic disease were examined using categorical comparisons. 259 patients were included in this study.94 patients had RA and 165 had SpA. The mean age of the RA patients was 50.49 ± 11.82 years with a majority of females (84%). The mean age for the SpA patients was 36 ± 13.7 years with a majority of males (67.3%). The prevalence of LTBI in the RBSMR was 21.6%. This prevalence was at 24.8% in SpA patients, while it was at 15.9% for RA patients. After the comparison between positive and negative LTBI patients according to rheumatic disease, no demographic, clinical, or therapeutic characteristics were statistically associated with LTBI. This study found that in an endemic TB country like Morocco, a high prevalence of patients with SpA and RA had LTBI, and that RA patients had a lower prevalence than SpA patients.