AB0230 OPTIMIZED TREATMENT OF BIOLOGICAL DISEASE MODIFYING DRUGS IN ROUTINE CLINICAL PRACTICE: SURVIVAL STUDY ANDANALYSIS OF PATIENT CHARACTERISTICS
Authors: A. De Diego Sola, N. Alcorta Lorenzo, C. A. Egües, L. M. Lopez Dominguez, O. Maiz-Alonso, J. J. Cancio Fanlo, E. Uriarte Isacelaya, M. B. Irastorza Larburu, M. A. Aranguren Redondo, J. M. Belzunegui Otano
Journal: Annals of the Rheumatic Diseases (2021)

Background: Biological disease modifying drugs (bDMARD) has allowed a targeted approach to rheumatoid arthritis (RA). Once sustained remission is achieved, the use of bDMARDs at lower doses than indicated in data sheets is considered (optimized treatment, OT). Studies show that 33-64.2% of patients on OT lose remission in the first 6 months. Still, it is a feasible practice in selected patients. Objectives: We aimed to describe demographic, clinical, analytical and therapeutic characteristics of RA patients on OT in our hospital. Secondly, we wanted to study the survival of OT and to compare patients with survival longer or shorter to one year. Methods: We did a retrospective review of the medical records of RA patients who began OT between January 2014 and December 2018. We included patients on Abatacept(ABA), anti-TNF drugs and Tocilizumab (TCZ). We defined the end of OT as the restart of the usual dose. Continuous variables are described with mean and standard deviation (SD) and qualitative variables are shown in absolute value and percentage. We divided the sample into patients with OT survival greater than or equal to one year and patients with OT survival less than one year, after which the characteristics of both populations were compared. Categorical variables were analyzed using Pearsons chi and quantitative variables using Student’s t-test. Survival analysis was performed using a Kaplan-Meier estimator. Results: We identified 234 RA patients on bDMARD at our hospital, of which 53 (22.6%) had been optimized between January 2014 and December 2018: 39 (73.6%) with anti-TNF, 7 (13.2) with ABA and 7 (13.2%) with TCZ. Their characteristics are shown in table 1. It is worth mentioning the rate of monotherapy (43.3%)and the low number of bDMARD prior to optimization (median 0.71, SD 0.97). The median survival of OT was 33.8 months and thirty-nine patients (73.6%) maintained OT for at least one year (95%confidence interval, 0.59 to 0.83). When comparing patients with survival greater/equal versus shorter to one year (table 2), the only variable showing significant differences was the presence of erosions at beginning of OT (28 patients in the &gt;1 year group vs 7 in the &lt; 1 year group; p=0.012). Although the difference is not significant (p = 0.07), patients with a survival of less than one year had more time between the debut of disease and the beginning of the first conventional synthetic DMARD (csDMARD). Table 1. Characteristics of the sample (N=53) Female 40 (75.47%) Age at diagnosis (years) 49.54 (11.68) Active smoker 15 (33.33%) ACPA positive 36 (67.92%) mRF positive 44 (83.02%) Nodules 11 (20.75%) Extra-articular disease 11 (20.75%) Erosions* 35 (74.47%) Monotherapy at optimization 23 (43.4%) bDMARD* previous to OT 0.71 (0.97) Optimized bDMARD •ETN 20 (37.74%) •ADA 16 (30.19%) •ABA 7 (13.21%) •TCZ 7 (13.21%) •GOL 2 (3.77%) •CZB 1 (1.89%) DAS28 at •Diagnosis 4.88 (1.25) •Beginning – 1 st sDMARD 4.62 (1.6) •Beginning – 1 st bDMARD 4.98 (1.06) •Beginning – opt bDMARD 4.67 (1.17) •Optimization 1.88 (0.65) Months from diagnosis to introduction of 1 st sDMARD* 19.67 (35.01) Months from disease debut to low activity* 38.75 (30.34) Months in low activity until start of OT 23.73 (22.47) ACPA: anti-citrullinated protein antibodies; mRF: monoclonal rheumatoid factor; Erosions: presence of erosions at Optimization; bDMARD: biological DMARD; ETN: Etanercept; ADA: Adalimumab; ABA:Abatacept; TCZ:Tocilizumab; GOL:Golimumab; CZB:Certolizumab; Opt bDMARD: bDMARD optimized; csDMARD: conventional synthetic DMARD; Low activity: DAS28 &lt; 3.2 Conclusion: OT is a therapeutic option from which some patients could benefit. Maintenance of OT may be related to early start of DMARDs. More studies are needed to define the characteristics of patients who can safely benefit from OT. References: [1]Henaux S et al. Risk of losing remission, low disease activity or radiographic progression in case of bDMARD discontinuation or tapering in rheumatoid arthritis: systematic analysis of the literature and meta-analysis. Ann Rheum Dis 2018;77:515–522. Disclosure of Interests: None declared