Catechol‐O‐methyltransferase inhibitor tolcapone prolongs levodopa/carbidopa action in parkinsonian patients

Background

Rheumatoid factor (RF) and anti-citrullinated peptides antibodies (anti-CCP) are universally recognised negative prognostic factors in rheumatoid arthritis (RA). The majority of studies of early RA have focused on RF and anti-CCP positive patients. Much less is known about prognostic markers in seronegative RA. Several studies report worse drug survival and worse patient reported outcomes in women with RA. This affects outcomes such as the 28-joint disease activity score (DAS28) and the health assessment questionnaire (HAQ). How these differences relate to autoantibody status is unknown.

Objectives

To investigate if the relation between sex and clinical outcomes varies by autoantibody status in patients with early RA.

Methods

An inception cohort of patients with early RA (n=233; symptoms duration ≤12 months), recruited in 1995–2005, was studied. All the patients fulfilled the 1987 American College of Rheumatology criteria for RA. The patients were managed according to usual care, with no pre-specified protocol for pharmacotherapy or rehabilitation. In a structured follow-up program, all patients were examined by the same rheumatologist. In the present study we divided the patient population in three groups according to autoantibodies status: RF and anti-CCP seropositive (double positive), RF or anti-CCP seropositive, RF and anti-CCP seronegative (double negative). We examined the relation between sex and different outcomes at 12 months (EULAR good response, clinical remission (DAS28 <2.6), HAQ≤0.5 and low pain score (VAS pain 0–100 of <20) by means of logistic regression.

Results

Complete data on autoantibody status at baseline was available for 201 patients (mean age at inclusion 61 years, 72% female, 60% RF positive and 58% anti-CCP positive). Twenty-eight% of the patients were double negative, 27% were single positive and 45% were double positive. Mean baseline DAS28 was 4.53. All patients were treated with a conventional synthetic DMARD (48% with methotrexate). Oral glucocorticoids were prescribed in 38% of patients. At the 1 year follow up, 19% had a EULAR good response, 21% were in remission, 40% had low pain and 53% low HAQ. Male patients in the double negative group were more likely to reach remission (odds ratio (OR) 6.40; 95% confidence interval (CI) 1.6–26.2) and EULAR good response (OR 4.67; 95% CI 1.2–18.3) compared to females. There were no such associations among the double positive patients (Table). Results were similar in analyses adjusted for DAS28 at baseline (Table). There was a similar pattern among double negative patients for low pain at 1 year (OR for male vs female patients 2.25; 95% CI 0.58–8.67 – adjusted for baseline pain), but no association between male sex and low HAQ at 1 year in double negative patients (OR 0.99; 95% CI 0.23–4.22 – adjusted for baseline HAQ) or the other subgroups.

Conclusions

In the subgroup of patients with seronegative early RA, male patients are more likely than female patients to reach DAS28 remission and EULAR Good Response after treatment with conventional synthetic DMARDs.

Disclosure of Interest

G. Cagnotto Paid instructor for: Novartis, E. Rydell: None declared, L. Jacobsson Consultant for: Pfizer, Abbvie, Novartis, Eli-Lilly, C. Turesson Grant/research support from: Abbvie, Bristol Myers-Squibb, Roche, Consultant for: MSD, Bristol Myers-Squibb, Roche, Paid instructor for: Abbvie, Bristol-Myers Squibb, Janssen, MSD, Pfizer, Roche and UCB