AB0407 IMPACT OF SEROPOSITIVITY ON DRUG RETENTION OF BIOLOGICS AND JAK INHIBITORS -THE ANSWER COHORT STUDY

Background 2022 EULAR recommendation announced that biological disease-modifying antirheumatic drugs (bDMARDs) and janus kinase inhibitors (JAKi) are considered in the phase Ⅱtreatment of rheumatoid arthritis (RA). On other hand, serum factor (RF) anti-cyclic citrullinated peptide antibody (ACPA) titer reported to affect bDMARDs JAKi efficacy. However, we still lack reliable evidence impact RF ACPA on these agents’ retention, which may reflect both effectiveness safety. Objectives The aim this multicenter (7 university-related hospitals) [1,2] , retrospective study was clarify or treatment retention patients with RA, be useful for adequate selection a real-world setting. Methods This assessed 5,343 courses introduced from 2001 (TNF [TNFi]=2,724, anti-IL-6 receptor [aIL-6R]=1,227, cytotoxic T lymphocyte-associated antigen-4-Ig [CTLA4-Ig]=906, JAKi=486; bDMARDs/JAKi naive cases 50.6%, baseline age 60.0 years, female 83.5%, disease duration 10.3 DAS28-ESR 4.3, positivity 78.3%, ACAP 82.8%, combined methotrexate [MTX] dose 8.4mg/week [47.8%], prednisolone [PSL] 5.9mg/day [28.2%]). Patients were classified into three groups according their (IU/mL) (U/mL) titer: negative (RF<15 ACPA<4.5), low positive (15≦RF<100 4.5≦ACPA<100), high (100≦RF 100≦ACPA), respectively. Reasons discontinuation four categories by each attending physician: 1) (primary secondary), 2) toxic adverse events (infection, malignancies, cardiovascular events, et al.), 3) non-toxic reasons (patient preference pregnancy, 4) remission. Retention rates reason estimated at 24 months using Kaplan-Meier method adjusted potential clinical confounders (age, sex, concomitant PSL MTX, switched number JAKi, prior use TNFi, aIL-6R, CTLA4-Ig, JAKi) Cox proportional hazards modeling. Results Adjusted as follows: due aIL-6R=21.4%, JAKi=27.1%, CTLA4-Ig=30.4%, TNFi=36.2% (Cox P<0.001 between 4 groups), CTLA4-Ig=12.1%, aIL-6R=12.5%, TNFi=13.3%, JAKi=14.6% P=0.369 groups). When categorized (Figure 1a), listed ascending order follows, respectively; (aIL-6R, 16.2%; 30.5%; 33.8%; 39.9%; P<0.001), 19.6%; 21.7%; 26.6%; 29.9%; P<0.001) 25.4%; 28.1%; 31.2%; 38.6%; P<0.001). 1b), 20.9%; 28.8%; 30.7%; 43.4%; 19.2%; 26.4%; 27.3%; 33.6%; 23.1%; 25.6%; 29.7%; 35.2%; Conclusion Considering effectiveness, aIL-6R showed highest continuation compared agents regardless RF/ACPA levels. CTLA4-Ig higher rates, although TNFi lower RF/ACPA-positive (low titer) RF/ACPA-negative cases. References [1]Ebina K, al. Drug tolerability seven biologics 4466 arthritis-the ANSWER cohort study. Arthritis Res Ther. Apr 11 2019;21(1):91. [2]Ebina Etani Y, Factors affecting drug Janus arthritis: Sci Rep. Jan 7 2022;12(1):134. Figure 1. Acknowledgements: NIL. Disclosure Interests Yuki Speakers bureau: Asahi-Kasei, Eisai, Eli Lilly, Mitsubishi-Tanabe Nippon Zoki., Grant/research support from: Lilly., Kosuke Ebina AbbVie, Amgen, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Janssen, Mitsubishi-Tanabe, Ono Pharmaceutical, Pfizer, Sanofi, Taisho, UCB Japan., Consultant of: Asahi-Kasei Teijin Pharma., Employee KE is affiliated Department Musculoskeletal Regenerative Medicine, Osaka University Graduate School supported Taisho., Yasutaka Okita Chugai Pharmaceutical., Yuichi Maeda Lilly Japan K.K., Pharmaceutical Co. Ltd., Pfizer Inc., Bristol Myers Mitsubishi Tanabe Pharma Corporation., Kohei Tsujimoto: None declared, Akira Onishi Squibb., Asahi Kasei Corp., K.K, Co., Eisai Abbvie Takeda Daiichi Sankyo Advantest, Ayumi, Health Care Science Institute., Advanced Medicine Rheumatic Diseases Nagahama City, Shiga, Japan, Toyooka Hyogo, five pharmaceutical companies (Mitsubishi Ltd, AYUMI Corp.). It also grants Ltd. Above-mentioned not involved design, data collection analysis, manuscript writing, submission., Hideo Onizawa: Takaichi Okano: Keisuke Nishimura: Ayaka Yoshikawa: Hideyuki Shiba Abbvie, GlaxoSmithKline Astellas Inc, Hideki Amuro: Yonsu Son: Motomu Hashimoto Kasei, Brystol Meyers, EA Pharma, Sankyo, Nihon Shinyaku, Novartis Mitsubishi., Tadashi Okano Janssen Mitsubishi.“, Ryota Hara Wataru Yamamoto: Atsushi Kumanogoh Tanabe, Mitsubishi, Ono, Seiji Okada: declare.d.