Ab0605 Sdai Is the Disease Activity Measure With the Best Performance Compared to Boolean Remission Criteria 1.0 and 2.0. Data From the Cohort Real, a Nationwide Study of Brazilian Ra Patients

Background: Recently, the ACR and EULAR proposed new remission criteria for patients with RA (1), suggesting a revised version of the 2011 Boolean criteria (2). Although less rigid than its predecessor, the so-called Boolean remission 2.0, still remains difficult to apply in routine practice (strict and without the possibility of classifications other than remission), with the disease activity indices CDAI, SDAI, DAS28, and RADAI being more widely used in clinical practice. Objectives: In a large Brazilian population with RA, we compared patients who achieved the Boolean remission 1.0 and 2.0 criteria with those who achieved remission using the CDAI, SDAI, DAS28-CPR, DAS28-ESR, and RADAI. Methods: Eleven Brazilian public hospitals participated in the REAL study between 2015 and 2016. Patients with RA were included and underwent three visits over a one-year period, with evaluations of five indicators of disease activity at each visit: DAS28-PCR, DAS28-ESR, SDAI, CDAI, and RADAI. A post hoc evaluation of the baseline data was performed to compare the indicators tested and the Boolean remission criteria 1.0 and 2.0. ROC curve, sensitivity and specificity values, predictive values, accuracy, and likelihood ratios were calculated. Results: A total of 840 RA patients were assessed for remission using the Boolean remission criterion of 2.0. Of these, 89.8% were female, the average age was 50-65 years (IQR 25h-75h)), the average duration of the disease was 81-231 months (IQR 25-75h)), and 78.3% had rheumatoid factor. MTX was being used by 68.1% of patients Of these, 127 (17.8%) and 164 (19.5%) patients met the Boolean 1.0 and 2.0 criteria for remission, respectively. Using remission by Boolean criterion as a reference, the SDAI showed the best performance in the both versions (details in Table 1). The ROC curves for all the indicators evaluated are shown in Figure 1. Conclusion: In a large Brazilian population with RA, 1,7 % more patients achieved remission when the Boolean criterion 2.0 was applied instead of 1.0. For both versions of the Boolean criterion, the SDAI showed better diagnostic performance than the other activity indicators. With greater applicability to clinical practice, our data increase the external validity of the SDAI and reinforce its potential as the measure of choice for applying the treat-to-target strategy. REFERENCES: 1 Studenic P, Aletaha D, de Wit M, Stamm TA, Alasti F, Lacaille D, et al. American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision. Arthritis Rheumatol. janeiro de 2023;75(1):15–22. 2 Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LHD, Funovits J, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. março de 2011;63(3):573–86. Table 1. Comparative performance between fulfilling Boolean 1.0 and 2.0 criteria and remission by different activity measures. AUC: Area under the curve; PPV: Positive Predictive Value; NPV: Negative predictive value; LR+: Positive Likehood ratio; LR-: Negative Likehood Ratio Acknowledgements: NIL. Disclosure of Interests: None declared.