FRI0648 USEFULNESS OF THE ULTRASOUND IN THE DECISION-MAKING PROCESS ABOUT THE USE OF BIOLOGICALS IN PATIENTS WITH RHEUMATOID ARTHRITIS – EXPERIENCE OF REAL LIFE IN A MIDDLE NCOME COUNTRY
Authors: Edwin Castillo, Michael Cabrera, Diana Buitrago-Garcia, Pedro Santos-Moreno, Eva Cardozo, Ivania Ramirez, Danny Gomez, Sandra Farietta
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is an inflammatory autoimmune disease with a prevalence of 0.5 to 1% and the advances in pharmacological treatments offered to manage the disease have achieved many goals; however, the appearance of biologics has made the treatment of RA very costly, which has a great impact in the developing countries where accessibility to these therapies is lower. On the other hand, we now know that patients who are in clinical remission of disease activity by clinimetry in a significant percentage of cases may have the so-called subclinical activity that is found using ultrasound (US). <h3>Objectives</h3> To evaluate the usefulness of ultrasound within the component of evaluation of patients with moderate-severe activity of the disease before they are taken to a medical board making-decision process about the initiation or switching of biologics. <h3>Methods</h3> Once a rheumatologist has identified a patient RA with clinical indication for biological therapy, patient is sent, among other things, to a medical board to take a collegiate decision about beginning or switching of biologic therapy. Between 24 and 72 hours before the medical board decision, the patient undergoes an US (normally 12 joints are measured plus those clinically committed at that time), in order to determine if it presents disease activity by US which is considered negative for activity if the patient has synovitis ≤ 1 or has Power Doppler ≤ 1 in a single joint. <h3>Results</h3> During 12 months, 988 patients had clinical indication for using biologic based on moderate or high disease activity; they were evaluated by a multidisciplinary team to define the appropriateness of a therapy; mean DAS28 of patients was 4.81 ± 1.37; Once the patients were evaluated by US, the medical board of decisions did not in all cases decide to initiate or change a biological treatment.; the choices made by the team were: 30% initiated or re-initiated biological therapy, in 29% of cases the team decided to wait and continuing observing the patient, 22% were switched to other biologic therapies, 12% did not have indication to start biological therapy because no activity by US and in 5% the medication dose was adjusted. Thus, in a total of 41% of the patients, biological therapy was not started or changed, which is important from the point of view not only clinical but also of the health payers. <h3>Conclusion</h3> Basically, this study shows that in patients with clinical indication of biological therapy by RA activity, a previous evaluation and a ultrasound are necessary in order to have a more accurate approach in making decisions; ultrasound is a practical, real-life, low-cost test to define activity in RA patients. Also we avoid high costs therapies for the management of rheumatoid arthritis, therefore we contribute not only to the health outcomes of patients but the health economic aspects in the management of RA. <h3>Disclosure of Interests</h3> Edwin Castillo: None declared, Michael Cabrera: None declared, Diana Buitrago-Garcia: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Eva Cardozo: None declared, Ivania Ramirez: None declared, Danny Gomez: None declared, Sandra Farietta: None declared