P122 Secular trends in prescription of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in rheumatoid arthritis: Experience from a UK regional centre (2016-2022)
Authors: Muhammed Hafis , Osborn Hayley , Hughes Kay , Yau Augustus , Hirsch George , Raizada Sabrina , Sheeran Thomas , Venkatachalam Srinivasan 
Published: April 2024

Abstract

Background/Aims
In the past two decades, biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) have substantially transformed the treatment landscape for rheumatoid arthritis (RA). With the emergence of new molecules, the introduction of cost-effective biosimilars, and the impact of the COVID pandemic, the treatment preferences might have shifted over time. We aim to explore the evolving trends in the prescription of biologic and targeted synthetic DMARDs in RA patients whose disease was refractory to conventional DMARDs.

Methods
A biologic registry was set up sourcing data from pharmacy and departmental records. Data of RA patients who were commenced on biologics or targeted synthetic DMARDs between January 2016 and December 2022 are presented descriptively without formal statistical assessments. Line plots depict prescription trends over the years. Data visualization done using R studio (v 2023.06).

Results
We have 1504 out of the 2345 patients in our biologic registry with RA; 827 of these patients commenced the treatment in the 7-year study period. Over the years, biosimilars are increasingly being preferred as the first-line agents. If a biosimilar for a biologic drug was available, all prescriptions were for the biosimilar in 2022. There was a significant drop (43.7%) in biologic prescriptions during the pandemic in 2020 compared to the previous year. However, by the next year, prescriptions rebounded to 91% of their pre-pandemic levels. TNF inhibitors and Janus kinase (JAK) inhibitors were the most common treatments initiated. There was a steady increase in the prescription of JAK inhibitors since their introduction in 2017. During the pandemic, JAK inhibitors were the most preferred agents for RA. However, a decline in their prescriptions was noted in 2022, down 36% from the previous year, possibly due to emerging concerns about their cardiovascular safety. While there was reduction in prescription of all biologics during pandemic, anti B cell therapy had the steepest decline (74.1% reduction in 2020 compared to previous year). This may be due to the increased risk of SARS-CoV-2 infection and impaired response to the vaccine with Rituximab. This trend is gradually reversing. Rates of prescription of abatacept and anti-IL6 agents remained fairly stable across the seven years.

Conclusion
Significant fluctuations are evident in the trend of prescription of biologic and targeted synthetic DMARDs in patients with rheumatoid arthritis in a regional centre in UK. We conclude that availability of biosimilars, safety data on JAK inhibitors and impact of the COVID pandemic had influenced the prescription trends.

Disclosure
H. Muhammed: None. H. Osborn: None. K. Hughes: None. A. Yau: None. G. Hirsch: None. S. Raizada: None. T. Sheeran: None. S. Venkatachalam: None.