OP0345 DOES IMMUNOLOGICAL REMISSION, DEFINED AS DISAPPEARANCE OF AUTOANTIBODIES, OCCUR WITH CURRENT TREATMENT STRATEGIES? A LONG-TERM FOLLOW-UP STUDY IN RHEUMATOID ARTHRITIS PATIENTS WHO ACHIEVED A SUSTAINED DMARD-FREE STATUS

Background Sustained disease modifying antirheumatic drug (DMARD)-free status, the sustained absence of synovitis after cessation of DMARD-therapy, is infrequent in autoantibody-positive RA, but approximates cure (i.e. disappearance of signs and symptoms). It was recently suggested that immunological remission, defined as disappearance of anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF), underlies this outcome.1 However, the association between seroreversion and cure of disease has not been extensively studied before. Objectives To determine in a long-term observational study if autoantibodies disappear in RA-patients who achieved sustained DMARD-free remission. Methods We studied 95 ACPA- and/or RF-positive RA-patients who achieved DMARD-free remission after median 4.8 years and kept this status for the remaining follow-up (median 4.2 years). Additionally, 21 autoantibody-positive RA-patients with a late flare, defined as recurrence of clinical synovitis after a DMARD-free status of ≥1 year, and 45 autoantibody-positive RA-patients who were unable to stop DMARD-therapy (during median 10 years) were studied. Anti-CCP2 IgG, IgM and RF IgM levels were measured in 587 samples obtained at diagnosis, before and after achieving DMARD-free remission. Results 12.8% of anti-CCP2 IgG positive RA-patients had seroreverted when achieving remission. In RA-patients with a late flare and with persistent disease this was 8.3% and 5.7%, respectively (p=0.63, Figure). For anti-CCP2 IgM and RF IgM similar results were observed. Evaluating the estimated slope of serially measured levels revealed that RF-levels decreased more in patients with than without remission (p Conclusion Sustained DMARD-free status in autoantibody-positive RA was not paralleled by an increased frequency of reversion to autoantibody-negativity. This form of immunological remission should therefore not be a treatment target. Reference [1] Schett G, Emery P, Tanaka Y, et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann Rheum Dis 2016;75:1428–37. doi:10.1136/annrheumdis-2016-209201 Disclosure of Interests Debbie Boeters: None declared, Leonie Burgers: None declared, Rene Toes Grant/research support from: Sanofi, Annette van der Helm - van Mil Grant/research support from: The research leading to these results has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting grant, agreement No 714312) and from the Dutch Arthritis Foundation. The funding source had no role in the design and conduct of the study.