P106 An evaluation of the Sheffield Rheumatology Biologics MDT
Authors: Nock Rebecca J , Maxwell James R 
Published: April 2022

Abstract

Background/Aims
Biological disease-modifying anti-rheumatic drugs (bDMARDs) account for a significant proportion of pharmaceutical expenditure in the NHS. In 2016, Manchester Royal Infirmary implemented the first Biological Rheumatology MDT to reduce variation in biologic prescribing. A similar care model was implemented in Sheffield Teaching Hospitals (STH), which we evaluate here. This evaluation aimed to answer the following questions: has the MDT improved the cost-effectiveness of biologic prescribing in STH, do anti-drug antibodies (ADAB) influence subsequent biologic treatment, are IL-6 or JAK inhibitor monotherapies more clinically effective than anti-TNF monotherapy in rheumatoid arthritis (RA) and what happens when no biologic treatment is advised?

Methods
The MDT keeps a real-time record of discussions containing patient demographics, previous therapies, and MDT decisions. This includes all MDT meetings over a 32-month period. This was merged with a database containing the current biologic therapy of all STH rheumatology patients, and a notes-review confirmed accuracy. For economic evaluation, a similar database was produced for patients commenced on biologics in the 6 months prior the MDTs introduction.

Results
Over the 32-month period of the MDT, there were 994 discussions about 796 patients. Concomitant conventional DMARD therapy was used in 63% of patients. 89% of patients discussed continue to use biologic therapies. The biologic MDT resulted in a 26% decrease in cost during the first 6 months of the MDT when compared to 6 months before the MDT. This was attributed to the increased use of biosimilars and evidence-based decision making. There was improved drug survival, with 28% of pre-MDT patients requiring a subsequent change to an alternative biologic, compared to 21% of patients in the MDT group. Secondary ADAB-positive failure is the commonest cause of ADAB-forming anti-TNF failure across all diagnoses. This commonly prompts a class switch in RA (where there are a wider range of NICE approved therapies), and a switch to etanercept (with the advantage of reduced immunogenicity when compared to other Anti-TNFs) in ankylosing spondylitis and psoriatic arthritis. IL-6 inhibitors and JAK inhibitors perform more favourably as monotherapies than anti-TNFs. 21% of patients in each of the IL6 inhibitor and JAK inhibitor monotherapy groups required alternative biologic therapy, compared to 42% in the anti-TNF monotherapy group. Of the 51 patients in whom no biologic was initially advised, 61% went on to receive a biologic.

Conclusion
The bDMARD MDT in STH has improved the standardisation of biologic prescribing across the rheumatology team. This evaluation has demonstrated significant improvements in cost-effectiveness and treatment retention compared to the 6-month period prior to the MDTs introduction. The evidence-base is effectively enforced by the MDT, which improves patient experience by improving drug survival. We recommend implementing a biologics MDT within other services to ensure equitable and cost-effective prescribing.

Disclosure
R.J. Nock: None. J.R. Maxwell: Other; JRM has served on advisory boards for Abbvie, Pfizer, BMS and Lilly and has received speaking honoraria from Pfizer, BMS, Novartis and Lilly.