THU0200 THE CHOICE OF BDMARD OR TSDMARD AS FIRST LINE THERAPY: DATA OF THE TARDIS-RA REGISTRY, A NATIONWIDE BELGIAN BIOLOGIC REGISTRY
Authors: D. De Cock, P. Durez, D. Elewaut, B. Lauwerys, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2020)

Background: The Tool for Administrative Reimbursement Drug Information Sharing (TARDIS) is an electronic platform combining data collection from all Belgian patients with Rheumatoid Arthritis (RA) on advanced therapy, together with a drug reimbursement request. Therapy choice after initial 2 classical synthetic DMARD failure is left to the treating rheumatologist in Belgium. Objectives: To investigate first-line therapy choices for tumor necrosis factor inhibitor (TNFi) biologic (b) DMARDs, non-TNFi bDMARDs or targeted synthetic (ts) DMARDs via patient characteristics and initial treatment response in the TARDIS-RA registry. Methods: All Belgian rheumatologist inserted patient data online when prescribing a b/tsDMARD. When data was entered for the first time, previous and current use of DMARD therapies was registered. Every next bDMARD or tsDMARD initiation, prolongation and discontinuation was registered electronically. First prolongation is 6 months for bDMARDs and 12 weeks for tsDMARDs, and yearly thereafter. Patients were selected for this analysis if they started a TNFi, non-TNFi or tsDMARD therapy between Jan 2018 and Jan 2019. Rituximab was excluded. Baseline characteristics of bionaive patients per therapy were compared with Mann-Whitney U or Chi 2 tests were appropriate. Regression analyses, adjusted for age, DAS28 baseline and disease duration, evaluated DAS28 change, remission (DAS28&lt;2.6) and low disease activity (LDA, DAS28&lt;3.2) between b/tsDMARDs at first TARDIS follow-up. Results: In 2018, 1263 bionaive RA patients were included. Table 1 describes this population. Time until 1 st follow-up differed between groups with 183 (181-184) days for bDMARD versus 84 (84-84) days for tsDMARD patients. Lineair regression showed an effect of therapy type on DAS28 change in bionaive patients (p=0.017). Logistic regression showed no difference per therapy for remission (p=0.090) nor low disease activity (p=0.123). Proportions of therapy prolongations at 1 st follow up visit did not differ per therapy type. Table 1. Baseline characteristics and treatment response of first-line TNFi, Non-TNFi or tsDMARDs TNFi Non-TNFi tsDMARD p-value Number patients 696 (57%) 293 (25%) 215 (18%) Age (years) 55, (45-64) 58, (51-68) 58, (49-66) &lt;0.001 Disease duration (years) 3, (1-7) 3, (1-9) 5, (2-13) &lt;0.001 DAS28 Baseline 4.8, (4.3-5.5) 5.1, (4.4-5.7) 4.7, (4.2-5.4) 0.010 DAS28 Change 2.2 (1.0-3.0) 2.2 (1.1-3.2) 1.9 (0.9-2.7) 0.014 Remission 296 (50%) 123 (49%) 78 (42%) 0.143 LDA 377 (64%) 153 (61%) 105 (56%) 0.196 Prolongation therapy 492 (82%) 219 (87%) 161 (86%) 0.158 Number given are median, (IQR) or number (proportion). TNFi = tumour necrosis factor inhibitor, ts= targeted synthetic, DAS = disease activity score, DAS28 change = DAS28 at 1st follow up visit minus DAS28 at baseline, remission = DAS28&lt;2.6), LDA = low disease activity = DAS28&lt;3.2), Prolongation = therapy was continued at 1st follow-up visit. Mann-Whitney U or Chi square tests were used where appropriate. Conclusion: Initial therapy choices are partially driven by patient profile, although other factors such as patient preferences could not be verified. DAS28 change for tsDMARDs seemed less important versus bDMARDs, but can possibly be attributed to the preset evaluation moment being sooner for tsDMARDs versus bDMARDs aside of patient profile differences in age and disease duration. In contrast, proportion of remission, low disease activity and therapy prolongation did not differ by therapy. Disclosure of Interests: Diederik De Cock: None declared, Patrick Durez Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Pfizer, Sanofi, Dirk Elewaut: None declared, Bernard Lauwerys: None declared, Rene Westhovens Grant/research support from: Celltrion Inc, Galapagos, Gilead, Consultant of: Celltrion Inc, Galapagos, Gilead, Speakers bureau: Celltrion Inc, Galapagos, Gilead, Patrick Verschueren Grant/research support from: Pfizer unrestricted chair of early RA research, Speakers bureau: various companies