OP0001 THE PRESCRIPTION OF NSAIDS FOR PATIENTS WITH INFLAMMATORY ARTHRITIS IS ASSOCIATED WITH PATIENT BUT NOT PHYSICIAN ASSESSED DISEASE ACTIVITY MEASURES AND DECREASES WITH INITATION OF TNF INHIBITOR THERAPY
Authors: Olafur Palsson, Johan K Wallman, Thorvardur Jon Love, Meliha C Kapetanovic, Petur S Gunnarsson, Björn Gudbjornsson
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> TNFα-inhibitor therapy is effective in controlling several rheumatic diseases and has been shown to reduce pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for treatment of pain and stiffness in inflammatory arthritides and are the first treatment line in axial spondyloarthritis. <h3>Objectives</h3> To study the prescriptions of NSAIDs in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) registered in ICEBIO and matched controls, and explore their relationship with disease activity measures. In addition, to explore the impact of initial TNFα-inhibitor therapy on NSAID prescription rates. <h3>Methods</h3> All patients receiving biologic DMARD therapy in Iceland for rheumatic diseases are registered in a nationwide database; ICEBIO. The Icelandic Directorate of Health operates a prescription database that includes over 90% of all drug prescriptions in Iceland. On February 1<sup>st</sup>2016 we extracted data for all patients with RA, PsA and AS from ICEBIO along with all filled prescriptions for NSAIDs made two years before and after the initiation of TNFα-inhibitor therapy. We then extracted NSAID prescriptions for five randomly selected individuals matched on age, sex, and calendar time of TNF inhibition for each patient. <h3>Results</h3> Data from 366 patients with RA, 218 with AS, 251 with PsA and 4760 controls was included. Control group was prescribed a mean of 23 defined daily doses (DDD) of NSAIDs per year. In total the ICEBIO patients were prescribed 6.7 times more DDDs of NSAIDs than the controls or a mean of 149 per year. After initiation of TNFα-inhibitor therapy the use of NSAIDs was reduced to a mean of 85 DDD per year, or 3.9 times that of the controls. Among the patients with RA, consumption was reduced by 43% (mean 148 to 85 DDD/year), 47% in the AS group (154 to 83 DDD/year) and 43% in the PsA group (157 to 90 DDD/year). The 20% of patients who used the largest amounts of NSAIDs over the 4 year period reported worse visual analogue scale (VAS) pain scores (mean±SD 65±20 to 60±23), VAS global health scores (70±19 to 65±23), and HAQ scores (1.19±0.64 to 1.03±0.67) when TNFα-inhibitor therapy was initiated compared to the rest of the ICEBIO group (p&lt;0.05 by students t-test), though there was no statistically significant difference in the number of swollen (4.5±4.7 vs 4.2±4.4) or tender (5.4±4.8 vs 5.5±5.4) joints or in the physician global VAS assessment (56±17 vs 57±18). <h3>Conclusion</h3> Patients with inflammatory arthritidies requiring TNFα-inhibitor therapy use more NSAIDs than general population controls, but consumption is significantly reduced following the initiation of the first-line biologic drug. The patients with the highest NSAID use have worse patient reported outcome measures but physician outcome measures are similar, which may suggest a non-inflammatory etiology of the pain. <h3>Disclosure of Interests</h3> Olafur Palsson: None declared, Johan K Wallman Consultant for: Consultant for AbbVie, Celgene, Eli Lilly, Novartis, and UCB Pharma., Thorvardur Jon Love Consultant for: Received reimbursment from Celgene for speaking about guidelines for the treatment of psoriatic arthritis, Meliha C Kapetanovic: None declared, Petur S Gunnarsson: None declared, Björn Gudbjornsson: None declared