AB0367 REASONS FOR DISCONTINUATION OF BIOLOGICAL DRUG AND TARGETED SYNTHETIC DRUGS AMONG PATIENTS WITH INFLAMMATORY ARTHRITIS IN THE UNITED ARAB EMIRATES (UAE)
Authors: Humeira Badsha, Ghita Harifi, Richard Kirubakaran, Bhavna Khan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In routine clinical care of Rheumatoid arthritis (RA) Spondyloarthritis(SPA) and Psoriatic arthritis (PSA) there is a high rate of discontinuation of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) due to loss of efficacy, side effects or lack of adherence. This can impact on the ability to achieve low disease activity. <h3>Objectives</h3> To evaluate the use of bDMARDs and tsDMARds and analyze the reasons for discontinuation of these drugs and to compare them to our standard DMARD Methotrexate. <h3>Methods</h3> In this retrospective cohort analysis we included consecutive patients aged ≥ 18 years with RA/SPA/PSA attending 2 Rheumatology clinics in the UAE from August- December 2019. Statistical analysis was performed using STATA version 13 and R-studio. Continuous data were summaries as mean and SD. Dichotomous data were presented as percentage. Chi square test, Proportion test and T-test were applied based on the data type and its distribution to calculated P-value at a 5% level of significance <h3>Results</h3> Of 745 patients who were included, 453 (60.8%) had RA,165(22.5%) SPA, and 127 (16.7%) PSA. Of these a total of 353(47.3%) received 565 treatment courses with bDMARDs and 106patients had (14.2%) had110 treatment courses with tsDMARD, and 480(64.4%) Methotrexate(MTX) 100/353(28.3%) of patients discontinued bDMARds; 35/106(33.0%) of patients discontinued tsDMARds; and 254/480(52.9%) MTX. 52% of treatment courses of bDMARD andd 36% courses of tsDMARD were discontinued. Reasons for discontinuation are in table 1. Factors such as age, gender,ethinicity were not significantly associated with the rate of discontinuation of medications (Chi-square test). 647/745(86.6%) of patients had medical insurance, however lack of insurance did not lead to discontinuation of bDMARDs (OR=0.54 95% CI (0.22 to 1.32)) and tsDMARDs (OR= 1.59 95% CI:(0.3 – 8.3)). A significant proportion of patients (15% -18%) in all the three groups have stopped the drugs of their own choice. We did not observe any statistical significant difference between the active and discontinued categories with respect to disease activity scores das 28 for RA; BASDAI for SPA and HAQ score for PSA. <h3>Conclusion</h3> A significantly higher proportion of patients discontinued MTX as compared to bDMARDs and tsDMARDs. Major reason for stopping MTX was side effects while bDMARDs and TsDMARDS were mainly stopped due to loss of efficacy or financial reasons. Safety and tolerability of bDMARDs and tsDMARDs was good in our cohort of patients. <h3>References</h3> [1] Ebina K,et al. Drug retention and discontinuation reasons between seven biologics in patients with rheumatoid arthritis -The ANSWER cohort study. PLoS One. 2018Mar15;13(3) [2] Favalli EG, et al. Real-life 10-year retention rate of first-line anti-TNF drugs for inflammatory arthritides in adult- andjuvenile-onset populations: similarities and differences. ClinRheumatol. 2017Aug;36(8):1747-1755. <h3>Disclosure of Interests</h3> None declared