ANTI-CCP IS AN INDEPENDENT PREDICTOR OF 12-MONTH EULAR RESPONSE IN PATIENTS WITH RA TREATED WITH ABATACEPT

Background: Although anti-cyclic citrullinated peptide (anti-CCP) positivity is regarded as a strong prognostic factor for untreated RA outcome, the benefit of anti-CCP tests for personalized medicine is controversial. Illustratively, anti-CCP was not predictive for response to anti-TNF in RA, as shown in meta-analyses, although some predictive value was shown for rituximab. There are, however, indications that better response to abatacept (ABA) is predicted by anti-CCP positivity. Objectives: To test whether anti-CCP level at baseline (BL) is an independent predictor for treatment response (DAS28 [CRP]-based EULAR response criteria) at 12 months (M) in patients (pts) with RA treated with ABA. Methods: Consenting pts with RA from Radboud UMC and Sint Maartenskliniek were consecutively included if they started treatment with ABA (BL). The anti-CCP values closest before BL were used. DAS28 (CRP) was assessed at BL and at 12M by trained rheumatology nurses or rheumatologists. Demographic and disease-related variables, treatment history and co-morbidity were also assessed. Primary outcome was response to treatment based on DAS28 (CRP) EULAR response criteria at M12. Therapy cessation was regarded as non-response. Multiple imputation with 20 repetitions was used to replace missing predictors. Multivariate logistic regression was used to examine whether anti-CCP positivity was an independent predictor for treatment response, taking confounding BL covariates (Table variables) into account. Results: Data were available for 200 pts with RA starting ABA. Mean (SD) age was 58 (13) years, 165 (83%) were female and median (p25–p75) disease duration was 12 (7–19) years (Table). Overall, 121 (61%) pts were anti-CCP positive at BL. At 12M, 86 (43%) pts remained on ABA. In the univariate model, anti-CCP was a predictor for treatment response (odds ratio 2.51; 95% CI 1.1, 6.0; p=0.038). No relevant confounding was present. Table 1. Baseline Characteristics Abatacept (n=200) Age, years, mean (SD)58 (13) Female, n (%)165 (83) RF+, n (%)128 (64) Anti-CCP+, n (%)121 (61) No. of previous bDMARDs*3 (3–4) No. of previous csDMARDs*3 (2–4) Oral glucocorticoids, n (%)79 (40) Disease duration, years*12 (7–19) Treatment duration, months*8 (4–28) NSAID, n (%)117 (59) Concomitant DMARD, n (%)117 (59) Overweight (BMI >25.0 kg/m), n (%)98 (48) *Median (p25–p75). RF+: IgM-Rheumatoid factor positivity. b/csDMARD=biologic/conventional synthetic DMARD. Conclusions: Anti-CCP positivity was confirmed as an independent predictor for treatment response at 12M in pts with RA treated with abatacept. As indicated by meta-analysis and systematic reviews, anti-CCP is not predictive for the response to anti-TNFs. Additional studies are needed to evaluate whether abatacept could be a preferable treatment in anti-CCP-positive pts. References: Taylor P, et al. Autoimmune Dis 2011;2011:815038. Lv Q, et al. PLoS ONE 2014;9:e89442. Isaacs JD, et al. Ann Rheum Dis 2013;72:329–36. Cuppen BV, et al. Rheumatology (Oxford) 2016;55:826–39. Gottenberg JE, et al. Ann Rheum Dis 2012;71:1815–19. Sokolove J, et al. Ann Rheum Dis 2015;74(Suppl 2):675. Huizinga TWJ, et al. Ann Rheum Dis 2015;74(Suppl 2):234–5. Disclosure of Interest: A. den Broeder Grant/research support from: CZ, Menzis, ZonMw, Consultant for: Amgen, Boehringer Ingelheim, Speakers bureau: Bristol-Myers Squibb, Pfizer, T. Kerstens: None declared, J. Fransen Grant/research support from: Bristol-Myers Squibb, C. van den Ende: None declared, L. Tweehuysen: None declared, R. Postema Employee of: Bristol-Myers Squibb, E. Alemao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, F. van den Hoogen Consultant for: Celltrion, Sandoz, Mundipharma and Biogen, Speakers bureau: Celltrion, Sandoz, Janssen, Egis DOI: 10.1136/annrheumdis-2017-eular.2477Citation: Annals of the Rheumatic Diseases, volume 76, supplement 2, year 2017, page 568Session: Rheumatoid arthritis - other biologic treatment (Poster Presentations )