AB0556 DO CONVENTIONAL SYNTHETIC DMARDs STILL PLAY A ROLE IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS IN THIS ERA OF BIOLOGICALS/JAK-INHIBITORS – A REAL-WORLD PROSPECTIVE DATA FROM A TERTIARY CARE CENTER IN SOUTH INDIA DR. PRABHU VASANTH 1, DR. ARVIND GANAPATI1, DR. BANUPRIYA G, DR. JOHN MATHEW1

Background: Conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) remained the mainstay of treatment of Rheumatoid Arthritis for decades. However, their use in day-to-day practice has come down in the last few years due to the advent of Biologic DMARDs and Targeted Synthetic DMARDs(JAK Inhibitors). B-DAMRDs are inaccessible to most patients in resource-poor countries due to high costs. Though generic JAKIs are widely available, their safety and efficacy in the long term have not been tested. So, even today the use of a combination of csDMARDs remains the first line of therapy for RA in most developing countries including India. Objectives: To estimate the extent of the response to cs-DMARDs in patients with newly diagnosed or early RA. Methods: In this prospective study, consecutive patients diagnosed with RA with a disease duration of less than 3 years in a tertiary care center in India between Jan 2020 and July 2022 have been included. This study has been approved by the Institutional Review Board (IRB) in the Christian Medical College, Vellore, Tamil Nadu, India. Their baseline data including their age, disease duration, comorbidities, socioeconomic status, smoking status, steroid dosage, and disease activity parameters including CDAI, SDAI, and DAS28 were noted at the baseline and every 3 months till 1 year. The primary outcome is the percentage of patients attaining Remission or Low Disease Activity State by the end of 1 year. The patients may be initiated on monotherapy, dual therapy, or triple therapy with csDMARDs based on the treating physician's discretion. Complete remission is defined as the attainment of remission in all the 3 disease activity parameters (CDAI, SDAI, DAS28), and partial remission is defined as the attainment of remission or Low Disease Activity (LDA) in at least 2 of the 3 disease activity parameters. If the patients have lost follow-up or if they have defaulted on treatment they will be excluded from the final analysis. Adverse events, if any will be noted, and if the csDMARDs are changed to any biological or ts-DMARD it will be considered a treatment failure. The descriptive data are presented as mean± SD or median (Interquartile range) or percentages. Fisher's exact test and Mann-Whitney U test were used to compare categorical and continuous parameters respectively. Results: A total of 240 patients were included in the study out of which 80 have been excluded due to drug default or missed follow-up. 160 patients with a median disease duration of 16(±10.25) months were included in the final analysis of whom 80% were females. The baseline age of the study population was 42 (±15.75) years and their ESR was 44.5 ±17, CRP 31.5±19.98mg/L, CDAI 19.8 ±6.45, SDAI 23 ±6.8, DAS28 5.2 ±0.945 respectively. 5% of them were active smokers and the median steroid dosage was 10(±2.5) mg of prednisolone or its equivalent at the baseline. 4(2.5%) patients were on monotherapy,36(22.5%) patients were on dual therapy and the rest 120 (75%) were on triple therapy. At the end of 1 year, overall, 128/160 (80%) of the patients have achieved low disease activity or remission (Figure 1). Among them, 96(60%) patients had achieved complete remission, and 32 (20%) patients attained a low disease activity state. The median steroid at the end of the study was 0(±2.5) mg. Higher swollen joint count at baseline, Higher CDAI, SDAI & and DAS 28 scores at baseline predicted non-response. Smoking does not seem to affect the outcome in non-responders nor the presence of comorbidities and poor socioeconomic status. 24 patients (15%) discontinued csDMARDs due to non-efficacy and were labeled as treatment failures. No significant adverse events were noted. Conclusion: The combination of csDMARDs is efficacious as the first line of therapy for RA in Indian patients even in the current era of JAKIs and biologicals thus proving the old saying "Old is Gold" and their use should be encouraged. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.