First-line treatment patterns of patients with rheumatoid arthritis who are anti-cyclic citrullinated peptide antibody positive versus negative

Document Type

Conference Proceeding

Publication Date


Publication Title

Ann Rheum Dis


Background: Patients with RA who are at a higher risk for progressive and destructive arthritis could be identified using anti-cyclic citrullinated peptide (anti-CCP) levels.1 Treatment guidelines recommend the use of non-biologic DMARDs as initial treatment in RA; but, if warranted, biologic (b)DMARDs could be considered in early treatment of RA.2 Real-world data describing treatment patterns based on anti-CCP designations are limited.

Objectives: This study evaluated treatment patterns of patients with RA who are anti-CCP positive (+) or negative (-).

Methods: This retrospective study was based on electronic medical record (EMR) data with a supplemental chart review from a large integrated delivery system. Patients newly diagnosed with RA (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 714.0x) were identified between 1 January 2009 and 31 December 2014. The first RA diagnosis date was designated as the index date. Patients were required to have 12 months of continuous activity in the EMR (6 months pre- and 6 months post-index). Based on the baseline anti-CCP test results, patients were categorized as anti-CCP+ (≥7.0 U) or anti- CCP- (<7.0 U). First-line therapy (time to treatment initiation, treatment regimen, treatment changes and response to treatment) was evaluated in the post-index period. Response to treatment was determined based on physicians' notes.

Results: Overall, 217 anti-CCP+ and 191 anti-CCP- patients with RA were included in this study. A higher proportion of anti-CCP+ (153, 70.5%) than anti- CCP- patients (44, 23.0%; p<0.0001) initiated treatment, generally within 1 month after diagnosis (anti-CCP+, mean [SD]: 31.1 [42.1] days and anti-CCP-, 28.1 [37.4] days; p=0.6538). MTX was most commonly used as first-line therapy. More anti-CCP+ than anti-CCP- patients received MTX (73.2 vs 56.8%; p=0.0374), while more anti-CCP- than anti-CCP+ patients received hydroxychloroquine (31.8 vs 13.1%; p=0.0037). Only three anti-CCP+ and no anti-CCP- patients were treated with a bDMARD. Response to treatment was similar between the cohorts (p=0.2444); 22.9% of anti-CCP+ and 18.2% of anti-CCP- patients had a complete response to the first-line therapy, and 33.3% of anti-CCP+ and 25.0% of anti- CCP- patients had a partial response to the first-line therapy. Treatment change, however, significantly differed between the two cohorts (p=0.0058); 11.1 and 9.1% of patients discontinued, 9.8 and 9.1% of patients switched, and 3.9 and 9.1% of patients augmented in the anti-CCP+ and anti-CCP- cohorts, respectively. Treatment changes occurred approximately 3 months after treatment initiation (anti-CCP+, 82.0 [49.7] days and anti-CCP-, 83.8 [52.7] days; p=0.9178).

Conclusions: After diagnosis of RA, patients who are anti-CCP+ were more likely to start therapy, indicating that physicians were more aggressive in treating this cohort. Patients were treated according to guidelines with non-biologic DMARDs, predominantly MTX. Patterns of treatment change differed between the cohorts; however, treatment response was similar with a complete response rate of 20%.




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