FRI0077 SHORT DURATION OF CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (CSDMARDS) BEFORE AND AFTER BECOMING A CSDMARD INADEQUATE RESPONDER IN RHEUMATOID ARTHRITIS PATIENTS
Authors: Robin K Dore, Jenya Antonova, Huang Huan, Magdaliz Gorritz, Mark C. Genovese
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> ACR guidelines recommend starting rheumatoid arthritis (RA) treatment with conventional-synthetic (cs)DMARD monotherapy<sup>1</sup>. If disease activity remains moderate or high, the guidelines recommend adding or switching to another csDMARD, biologic (b)DMARD, or janus kinase inhibitors (JAKi) for established RA. In early (&lt;6 months) RA, the guidelines recommend tumor necrosis factor inhibitors TNFi over JAKi and TNFi+methotrexate (MTX) over JAKi+MTX. <h3>Objectives</h3> This study aimed to investigate treatment patterns and duration in csDMARD IR patients. <h3>Methods</h3> In fully-adjudicated commercial medical and pharmacy health insurance claims database with ∼40 million lives annually, adult RA patients (≥2 RA diagnoses ≥30 days apart) who started csDMARD (1/1/2012—3/31/2017) and then switched to or added another DMARD (index date, ID) were selected. Real world treatment patterns of patients with ≥1-year continuous enrollment before (baseline) and after ID (index treatment) were assessed. <h3>Results</h3> Among 25,104 csDMARD initiators, 10,091 (40%) demonstrated IR, and 7,816 met all the inclusion and exclusion criteria (median age 54 years, 26% male). The baseline csDMARD treatment lasted for a median of 4.3 months and mostly comprised of monotherapy (96%). Upon treatment regimen change, 62% (n=4,869) initiated combination therapy (32% csDMARD+csDMARD, 28% csDMARD+TNFi, 1.4% csDMARD+other bDMARD, 0.5% csDMARD+JAKi) and 38% initiated monotherapy (27% on csDMARD, 10% TNFi, 0.7% other bDMARD, 0.5% JAKi). Post-switch, the median treatment duration was longer for combination therapy than monotherapy: 13.7 vs. 5.2 months (p&lt;0.001). Among next therapies, csDMARD showed the trend towards shortest durability and JAKi – toward longest durability. Among monotherapies the median treatment duration varied: 4.9 (csDMARD), 5.9 (TNFi), and 8.1 (JAKi) months (p=0.2, comparing all). The median duration of combination therapies lasted: 12.5 (csDMARD+csDMARD), 14.9 (TNFi+csDMARD), and 17.2 (JAKi+csDMARD) months (p= 0.04, comparing all). <h3>Conclusion</h3> The real-world evidence suggests that treatment durability may be better for JAKi than TNFi (both monotherapy and combination). The majority of csDMARD patients switched to another csDMARD, which showed short durability of treatment, suggesting that switching MOA may benefit these patients. <h3>Reference</h3> [1] Singh JA, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016 Jan;68(1):1-26 <h3>Disclosure of Interests</h3> Robin K Dore Grant/research support from: Gilead Sciences, AbbVie, Amgen, Lilly, Pfizer, Regeneron, Sanofi, Consultant for: AbbVie, Amgen, Lilly, Speakers bureau: AbbVie, Amgen, Lilly, Sanofi, Regeneron, Pfizer, UCB, Jenya Antonova Shareholder of: Gilead Sciences, Employee of: Eli Lilly and Company, Medimmune, Genentech, Gilead Sciences, Huang Huan Grant/research support from: Gilead Sciences, Magdaliz Gorritz Grant/research support from: Gilead Sciences, Mark C. Genovese Grant/research support from: Sanofi/Genzyme, Genentech/Roche, RPharm, Consultant for: Sanofi/Genzyme, Genentech/Roche, RPharm