AB0200 TRENDS IN THE CHOICE OF FIRST BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY
Authors: A. İ. Ertenli, U. Kalyoncu, O. Karadag, L. Kiliç, A. Akdoğan, I. Dogan, Ş. A. Bilgen, E. Bilgin, E. Duran, Y. Maraş, B. Kicasik, A. Erden, B. Armagan, A. Sari, E. C. Bolek, B. Farisoğullari, G. K. Yardimci, Z. Özsoy, G. Ayan, M. Çalgüneri, S. Kiraz
Journal: Annals of the Rheumatic Diseases (2021)

Background: In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest. Objectives: In this study, we aimed to explore the first biologic agent trends of our 20-years of single-center experience. Methods: HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported. Results: A total of 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs over time. Table 1. Distribution of first biologic DMARDs in RA patients according to 5-years periods 2001-2005 2006-2010 2011-2015 2016-2020 Total Adalimumab 15 (23.1) 111 (33.0) 187 (21.8) 153 (18.6) 466 (22.4) Etanercept 30 (46.2) 154 (45.8) 229 (26.7) 54 (6.6) 467 (22.4) İnfliximab 20 (30.8) 58 (17.3) 64 (7.5) 7 (0.9) 149 (7.1) Golimumab 0 0 37 (4.3) 43 (5.2) 80 (3.8) Certolizumab 0 0 37 (4.3) 68 (8.3) 105 (5.0) Anti-TNF 65 (100) 323 (96.4) 554 (64.5) 325 (39.5) 1267 (60.9) Tofacitinib 0 0 6 (0.7) 212 (25.8) 218 (10.5) Tocilizumab 0 0 9 (1.0) 102 (12.4) 111 (5.3) Rituximab 0 12 (3.6) 136 (15.8) 84 (10.2) 232 (11.1) Abatacept 0 0 153 (17.8) 99 (12.0) 252 (12.1) Non-Anti-TNF 0 12 (3.6) 304 (35.5) 497 (60.5) 813 (39.1) Total 65 (100) 335 (100) 858 (100) 822 (100) 2080 (100) Approval years of drugs in Turkey ; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015, Conclusion: Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors. Disclosure of Interests: None declared