Saturday, June 24, 2017

Dr. Strangfeld or: How I Learned to Stop Worrying and Love RABBIT – or RABBIT at the 2017 EULAR Annual Meeting in Madrid

I just couldn’t resist hinting at Stanley Kubrick’s masterpiece (1964): Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb [1]. Maybe you would have loved better [2]: Who framed Roger RABBIT? That’s an animation / live action movie by Robert Zemeckis (1988).

Dr. Strangfeld belongs to the team of the German registry on biologics. I’ve attended to some very good talks by her, but here I want to look at the whole team’s publications at the 2017 EULAR Annual Meeting in Madrid. “RABBIT is the German register for the long-term observation of therapy with biologics in adult patients with rheumatoid arthritis.” [3]

A. Strangfeld and colleagues presented [4]: „ RATES AND RISK FACTORS OF NEW-ONSET PSORIASIS UNDER DIFFERENT BIOLOGIC AGENTS AND CONVENTIONAL SYNTHETIC DMARD TREATMENT”. The authors used data of 12,722 patients matching 53,585 patient years. Conclusions: “… Our results confirmed a higher risk for TNFi 1 [5] and showed a similar result for abatacept. A lower but still significant increased risk was found for rituximab, whereas there was no difference for tocilizumab compared to csDMARDs. New onset psoriasis is a rare and most often non-serious event. The number needed to harm is 334 patients treated with TNFi for one year to observe one PsE [psoriatic event].” The interesting number is 334.

Another study is by Y. Meissner and colleagues [6]: “THE RELEVANCE OF POOR PROGNOSTIC FACTORS FOR ACHIEVING LOW DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: A COLLABORATIVE ANALYSIS OF THREE GERMAN COHORTS”. Conclusions: “Although autoantibodies and erosions were associated with treatment failure, their absence did not predict LDA [low disease activity]. Instead, baseline disease activity, functional status and glucocorticoid use may be more useful to guide treatment strategies when LDA is the target.” But still we have to discuss, how this fits into any treatment algorithm.

The next study by A. Richter and colleagues looked at other aspects of prognostic factors [7]: “EARLY TREATMENT RESPONSE TO CONVENTIONAL DMARD THERAPY IN RHEUMATOID ARTHRITIS IS A BETTER PREDICTOR OF LOW DISEASE ACTIVITY OR TREATMENT ESCALATION AT 12 AND 24 MONTHS THAN AUTOANTIBODIES OR EROSIONS”. In results we read: “More than one third of patients (34.2%) were treated with a combination of MTX and leflunomide (LEF), 23.6% with LEF mono, 20.8% with MTX + hydroxychloroquine (HCQ) or sulfasalazine (SSZ), 16.5% with MTX mono, and 4.9% with SSZ mono. …” Conclusions: “The highest impact on achieving LDA was found in disease activity at baseline and response to treatment within 3–6 month. The relevance of erosions and/or seropositivity regarding the prediction of a poorer outcome is disputable.” Seropositivity was defined as RF+/ACPA+. For some people it still makes a difference.

I think collecting data in registries is important. The abstracts presented at the 2017 EULAR Annual Meeting in Madrid demonstrate the wide range of possible applications. You might like to use the RABBIT Risk Score of Infections [9].

Links and References:
[4] DOI: 10.1136/annrheumdis-2017-eular.5092
[5] Hernandez et al., Arthritis Care Res 2013; 65:2024–31.
[6] DOI: 10.1136/annrheumdis-2017-eular.4697
[7] DOI: 10.1136/annrheumdis-2017-eular.4979


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