BIOLOGICAL MANAGEMENT IN RHEUMATOID ARTHRITIS: RESULTS OF A REAL-WORLD COHORT FROM THE NETHERLANDS

Background: Management of rheumatoid arthritis (RA) has improved dramatically due to early diagnosis, treat-to-target approaches based on disease activity measures, and the introduction of biological disease modifying anti-rheumatic drugs (bDMARDs). Tumor necrosis factor inhibitors (TNFis) are the most frequently prescribed bDMARDs after failure on conventional synthetic (cs)DMARDs. However, data on drug survival and predictors that influence the survival time are sparse. Moreover, drug survival could decrease with the number of bDMARDs that have been used. Objectives: To investigate drug survival for first and second line biologicals and factors that influence survival time. Methods: We used a retrospective observational cohort in which data were retrieved from the local pharmacy database and patient records of the Erasmus Medical Center in the Netherlands. We included patients who started with a TNF-inhibitor between 2000 and 2020 and were diagnosed with RA. Data on age, gender, disease duration, time to first biological, survival time, co-medication and reasons for discontinuation were collected. Results: Data were already derived from 216 RA patients ( table 1 ). Of the included patients 28 (13%) started their first TNFi within 6 months after diagnosis, while 56 (26%) patients started their first TNFi two years after diagnosis. Median (95%) survival time of the first-line biological was 1.6 years (1-2), and for the second-line biological 0.8 years (0.5-0.9). Biological survival was significantly longer for the first-line biological compared to the second (p=0.0008) ( Figure 1A ). Discontinuation reasons for the first-line biological were ineffectiveness (38%), adverse events (13%), remission (18%), pregnancy (17%), patient preference (4%) or other reasons (10%). Discontinuation reasons for the second-line biological were ineffectiveness (51%), adverse events (17%), remission (7%), pregnancy (13%), patient preference (2%) or other reasons (10%)( table 1 ). Drug survival for the first-line biological was significantly longer when it was combined with a csDMARD (p=0.05) ( Figure 1B ). Furthermore, multivariable cox regression analyses showed a significant relation between first-line biological survival time and gender (p=0.005, hazard ratio 0.28 (95% CI 0.12-0.68)) and erosions (p=0.004, hazard ratio 0.37 (95% CI 0.19-0.73)) when discontinuation due to remission was omitted from the analysis. Within aforementioned analyses we corrected for ACPA, age of diagnosis, age at first biological, and BMI. The chance that patients stopped with their biological due to remission was negatively influenced by having erosions (p=0.02, hazard ratio 0.07 (95% CI 0.007-0.66)) and positively influenced by age at first biological (p=0.03, hazard ratio 1.4 (95% CI 1.03-1.94)) in a multivariable cox model in which we corrected for gender, ACPA, erosions, BMI, and age of diagnosis. Table 1. Characteristics of patient population RA patients, n=216 Age at diagnosis, mean (sd ) 37.5 (16) Age at first biologic, mean (sd ) 42.4 (16) Gender, female, n (% ) 194 (90) ACPA positive, n (% ) 157 (73) RF positive, n (% ) 158 (73) Erosive disease, n (% ) 85 (40) BMI, mean (sd ) 26.9 (6.7) Time to first biological, years, mean (sd ) 4.9 (5.7) Discontinuation reasons 1 biological, n(% ) Ineffective 58 (38) Adverse event 20 (13) Remission 27 (18) Pregnancy 26 (17) Patient preference 6 (4) Other 16 (10) Discontinuation reasons 2 biological, n(% ) Ineffective 42 (51) Adverse event 14 (17) Remission 6 (7) Pregnancy 11 (13) Patient preference 2 (2) Other 8 (10) Conclusion: Median drug survival of the first biological is 1.6 years. Drug survival time is prolonged if patients are using co-medication and shortened in the presence of erosions. Furthermore, drug survival diminishes with the number of bDMARDs that are used. References: Disclosure of Interests: None declared Citation: Ann Rheum Dis, volume 79, supplement 1, year 2020, page 994Session: Rheumatoid arthritis - biological DMARDs (Poster Presentations)