TY - JOUR T1 - Positive impact on 10-year outcome of the window of opportunity for conventional synthetic DMARDs in rheumatoid arthritis: results from the ESPOIR cohort JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2021-002040 VL - 8 IS - 1 SP - e002040 AU - Joanna Kedra AU - Alexandre Lafourcade AU - Bernard Combe AU - Maxime Dougados AU - David Hajage AU - Bruno Fautrel Y1 - 2022/05/01 UR - http://rmdopen.bmj.com/content/8/1/e002040.abstract N2 - Objective This study aimed to assess the impact of disease-modifying antirheumatic drugs (DMARDs) on 10-year outcomes in rheumatoid arthritis (RA).Methods Patients with RA from the ESPOIR cohort with complete data on Disease Activity Score in 28 Joints (DAS28) and Health Assessment Questionnaire (HAQ) at 10 years (n=418) and complete radiographic data at baseline and 10 years (n=343) were included in this study. Outcomes were favourable outcome (FavOut) at 10 years, defined as DAS28 of <2.6 and HAQ score of <0.5 at 10 years, and absence of structural damage progression (AbsSDP) at 10 years, defined as change in Sharp-van der Heijde Score less than the smallest detectable change at 10 years (11.5 points). Three multivariate logistic regression models predicting 10-year outcome were built, considering (1) baseline variables only, (2) baseline variables and DMARD exposure (ever exposed, yes/no) and (3) baseline variables and DMARD exposure as weighted cumulative exposure (WCE) variables.Results Overall, 196/418 (46.9%) patients showed FavOut and 252/343 (73.5%) AbsSDP. WCE models had the best predictive performance, with area under the curve=0.80 (95% CI 0.74 to 0.87) for FavOut and 0.87 (95% CI 0.83 to 0.92) for AbsSDP. In the WCE model, the odds of FavOut and AbsSDP were reduced with conventional synthetic disease-modifying antirheumatic drug (csDMARD) initiation at 12 months versus at baseline (OR 0.78, 95% CI 0.65 to 0.94, and OR 0.89, 95% CI 0.76 to 0.98, respectively). Early biologics initiation was not significantly associated with either outcome.Conclusions WCE models can identify and quantify the long-term benefit of early csDMARD initiation on 10-year functional and structural outcomes in patients with RA.Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The data underlying this article will be shared on reasonable request to the corresponding author. The study protocol, consent form, case report forms, available data list, all scientific projects, newsletters and some others documents are on the cohort Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) website (www.lacohorteespoir.fr). The first patient was included on 13 November 2002, and the estimated completion date is 1 June 2025. The anonymised raw data are stored by the ESPOIR coordination centre and are non-publicly available. ER -