SAT0151 TIME TO INITIATION OF BIOLOGIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN THE FRENCH COHORT ESPOIR
Authors: Kedra Joanna, Benjamin Granger, Stephanie Emilie, Cecile Gaujoux-Viala, Anne-Christine Rat, Bernard Combe, Bruno Fautrel
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Access to biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) of early rheumatoid arthritis (RA) patients is highly variable across countries and may depend on patient characteristics, disease expression, physicians behaviors as well as care organization in the patient region of living. <h3>Objectives:</h3> 1) To assess the time to initiation of bDMARDs in the French cohort ESPOIR, and 2) To assess the factors associated with the timing of bDMARD initiation. <h3>Methods:</h3> In this national multicenter cohort, 813 adult patients with suspected or confirmed early RA were included between December 2002 and March 2005, and followed up during 10 years. In the present analysis, we considered only patients who were fulfilling the ACR-EULAR 2010 criteria for RA at baseline. The primary outcome was the time to initiation of a biologic DMARD, in months, since diagnosis. It was assessed by Cox model based survival analysis with time dependent covariates; the threshold used for p-value was 0.05. Predictors colinearity was then assessed by adapted tests. All statistical analysis were done with R version 3.5.1. <h3>Results:</h3> Among the 658 patients fulfilling the ACR-EULAR 2010 criteria for RA (77% women, 52% smokers at baseline, mean-aged 48 at diagnosis, with positive RF in 46.6%, positive ACPA in 43% and polyarticular presentation at baseline in 54.5%), 178 patients (31%, CI 95%= [27%;34.7%]) initiated a biologic DMARD during the 10-year follow-up (Figure 1). Variables associated with an earlier bDMARD initiation in the bivariate analysis were: 1) at baseline: younger age (p = 0.0016), younger age of first joint pain (0.0014), younger age of first joint swelling (0.0014), 2) during the follow up: joint pain (p &lt; 0.0001), high HAQ (p &lt; 0.0001) and DAS28 (p &lt; 0.0001), radiologic progression (p &lt; 0.0001), positive RF (p &lt; 0.0001), positive ACPA (p &lt; 0.0001), elevated ESR (p &lt; 0.0001) and CRP (p &lt; 0.0001). In multivariate analysis, DAS28 (p &lt; 0.0001), radiologic progression (p &lt; 0.0001) and positive ACPA (p=0.000176) were significantly associated with an earlier initiation of a biologic DMARD, whereas an older age of first joint pain was a protective factor (p &lt; 0.0001) (Table 1). <h3>Conclusion:</h3> In this study, less than one third of the ESPOIR cohort patients initiated a bDMARD over the 10-year follow-up. RA poor prognostic factors were associated with earlier initiation as expected. <h3>Disclosure of Interests:</h3> Joanna KEDRA: None declared, Benjamin Granger: None declared, Stephanie Emilie: None declared, Cecile Gaujoux-Viala Consultant for: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Speakers bureau: Speaking and/or consulting fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Merck-Serono, Medac, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Anne-Christine Rat: None declared, Bernard Combe Consultant for: Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, Sanofi Genzyme, SOBI, UCB