ALMOST TWO AND HALF PRECENTAGE OF RA PATIENTS HAD DIFFICULT TO TREAT (D2T): RESULTS FROM E.PULSE, THE NATIONWIDE HEALTH DATA

Background: Treatment of RA patients can sometimes be quite difficult. The necessity to use b/ts DMARDs with two different mechanisms of action is included in the definition of difficult-to-treat (D2T) RA [1]. Objectives: This study aimed to determine the clinical and demographic characteristics of D2T RA patients using biological/targeted synthetic DMARDs registered in the e.pulse database. Methods: Datasystem and patient selection; This nationwide cohort study utilized data from the Turkish Ministry of Health National Electronic Database, known as E-Pulse. The Ministry of Health employs Big Data technology to deliver services, with integrated systems such as e-Pulse and the National Healthcare Information System (NHIS). The E-Pulse system contains clinical records for more than eighty million individuals in Turkey, including demographic details, laboratory results, drug history, and comorbidities starting from 2016. In this analysis, cases of RA were identified using ICD-10 codes M05 (‘M05.0’, ‘M05.1’, ‘M05.2’, ‘M05.3’, ‘M05.8’, ‘M05.9’), M06 (‘M06’, ‘M06.0’, ‘M06. 1’, ‘M06.2’, ‘M06.3’, ‘M06.4’, ‘M06.8’, ‘M06.9’)] two times at least 30 days apart AND with at least one DMARD prescription AND without spondyloarthritis and/or psoriatic arthritis ICD codes were included. Data recorded in the e.Pulse systems between January 2016 and December 2022 were used. Definition of D2T RA; Patients who used b/ts DMARDs with at least two different mechanisms of action were defined as difficult RA. Results: Frequency of D2T in RA: Overall 46,764/347.902 (13.5%) patients using b/ts DMARDs were included. Among b/ts DMARD usage, 9176/46,764 (19.6%) patients were evaluated as compatible with D2T. In the entire RA population, 9176/346,209 (2.65%) had difficult RA. Demographic and Comorbidities of D2T vs only one b/tsDMARDs in RA: D2T RA patients are more often female (84.5% vs 77.3%, OR 95% CI 1.60 (1.51-1.70), RF positivity is more frequent (70.3% vs 61.5%, OR 95% CI 1.48 (1.41-1.55)), any connective tissue diseases (4.7% vs 8.8%, OR 95% CI 0.51 (0.46-0.57)), ILD (1.6% vs 2.0%, OR 95% CI 0.81 (0.67-0.96), chronic renal failure (3.1% vs 4.3%, OR 95% CI 0.71 (0.63-0.81), and malignancy (4.0% vs 6.4%, OR 95% CI 0.61 (0.55-0.69) are less frequent on the other hand depression (28.0% vs 25.9%, OR 95% CI 1.11 (1.05-1.17) and fibromyalgia (13.1% vs 10.3%, OR 95% CI 1.32 (1.23-1.41) are more frequent. Treatments of D2T vs only one b/tsDMARDs in RA: The use of any csDMARD, especially leflunomide (71.2% vs 49.9%, OR 95% CI 2.49 (2.37-2.61), was more frequent in D2T patients (Table 1). When anti-TNFs were taken as reference in the use of b/tsDMARDs in D2T patients, T cell blockers (9.2% vs 3.0%, OR 95% CI 3.28 (2.98-3.61), JAK inhibitors (20.8% vs 12. 8%, OR 95% CI 1.73 (1.63-1.85) and anti-IL6 (12.2% vs 7.7%, OR 95% CI 1.69 (1.57-1.83) more frequently, B cell blockers (11.0% vs 26.3%, OR 95% CI 0.45 (0.41-0.48) less frequently. Conclusion: Among the entire RA population, the prevalence of D2T according to b/ts DMARD use is 2.6%. The comorbidities of these patients differ from other patients and this may have an impact on the treatment decision. In addition to b/ts DMARDs, the use of csDMARDs, most commonly leflunomide and glucocorticoids, is prominent in D2T patients. Non-TNFi are used more frequently in D2T patients than in the single b/ts DMARD group, the exception being rituximab. The limitation is that other information about D2T is not known. REFERENCES: [1] Nagy G, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan;80(1):31-35. Table 1. Treatment strategies of patients Acknowledgements: NIL. Disclosure of Interests: None declared. DOI: 10.1136/annrheumdis-2024-eular.3305 Keywords: Epidemiology, Biological DMARD Citation: , volume 83, supplement 1, year 2024, page 1545Session: Rheumatoid arthritis (Publication Only)

Epidemiology, Biological DMARD