SAT0127 REAL-WORLD PREDICTORS OF STARTING DIFFERENT ADVANCED DMARD TREATMENTS IN RHEUMATOID ARTHRITIS: A PROSPECTIVE INVESTIGATION FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH) GROUP
Authors: M. Weiler, O. Schieir, M. F. Valois, S. J. Bartlett, L. Bessette, G. Boire, G. Hazlewood, C. Hitchon, E. Keystone, D. Tin, C. Thorne, V. Bykerk, J. Pope
Journal: Annals of the Rheumatic Diseases (2020)

Background: RA patients with inadequate DMARD response may be treated with a TNF inhibitor (TNFi), non-TNFi or janus kinase inhibitor (JAKi) [1]. Objectives: Compare characteristics of real-world early RA (ERA) patients starting TNFi, non-TNFi, and JAKi post DMARD failure. Methods: Data were analyzed from early RA patients (symptoms &lt; 1 year) enrolled in CATCH who started TNFi, non-TNFi or JAKi as first line advanced therapy from 2014 to 2019. Descriptive statistics, t-tests and chi-square tests summarized and compared secular trends and patient characteristics initiating each class of therapy. Multinomial logistic regression analyses were done. Results: 246 participants started advanced therapy during the study period; (75%) female, mean(SD) age 50(14) years. First line prescriptions for JAKi increased and TNFi decreased (Fig. 1). Those receiving JAKi had longer disease duration, fewer tender joints, and lower DAS28, CDAI, ESR, MD global (all p &lt;0.05) (Table 1). The strongest predictor of starting JAKi was province (Ontario where access is preferential for JAKi and biosimilar TNFi) (Table 2). Those prescribed TNFi had shorter disease duration, younger age, fewer comorbidities, and treatment location outside Ontario (Table 1,2). Those starting non-TNFi had higher DAS28; predictors included older age, higher education, and more comorbidities (Table 1,2). Table 1. Characteristics prior to starting advanced therapy Variable Total Sample (N = 246) JAKi (N = 61) TNFi (N = 153) Non-TNFi (N = 32) p-value £ Disease duration (months) mean (SD) 39 (34.1) 50.8 (39.3) 32.5 (29.1) 48 (38.6) 0.0006 DAS28 (ESR - CRP if ESR was missing) mean (SD) 4.2 (1.4) 3.6 (1.4) 4.3 (1.4) 4.8 (1.5) 0.0012 CDAI mean (SD) 21.5 (14.8) 16.5 (13.7) 22.9 (14.8) 24.8 (14.9) 0.0089 Tender joint count (0-28), median (IQR) § 4 (7) 2 (6) 5 (8) 6 (9) 0.0224 ESR median (IQR) § 13 (20) 12 (13) 13 (20) 28.0 (23.5) 0.0448 MD Global (0-10) mean (SD) 4.2 (2.7) 3.2 (2.7) 4.4 (2.6) 4.8 (2.8) 0.0030 § IQR: 75 – 25 percentile £ p-value: ANOVA for continuous variable, chi-square for categorical Table 2. Multinomial regression for initiating advanced DMARD therapy Disease stage &amp; Clinical Disease Activity Advanced DMARD Adjusted for Age, sex, education, comorbidity Fully Adjusted φ Non-TNF vs TNF JAK vs TNF Non-TNF vs TNF JAK vs TNF Age 1.01 (0.98, 1.05) 1.01 (0.99, 1.04) 1.01 (0.97, 1.05) 1.02 (0.99, 1.05) Women vs Men 1.98 (0.71, 5.58) 1.33 (0.63, 2.80) 2.35 (0.76, 7.27) 1.72 (0.73, 4.02) Education (&lt; HS vs ≥ HS) 2.92 (1.28, 6.63 ) 1.49 (0.78, 2.86) 2.83 (1.12, 7.15 ) 2.08 (0.97, 4.47) RDCI baseline 1.35 (1.01, 1.81 ) 1.21 (0.95, 1.53) 1.30 (0.95, 1.78) 1.23 (0.94, 1.60) Private Insurance (No vs Yes) NI NI 1.26 (0.47, 3.40) 0.99 (0.44, 2.25) RF Positive NI NI 1.47 (0.56, 3.85) 1.84 (0.82, 4.12) CDAI NI NI 1.01 (0.98, 1.04) 0.97 (0.94, 1.00) Region Quebec vs Ontario (ON) NI NI 0.59 (0.20, 1.72) 0.44 (0.20, 0.94 ) West vs ON NI NI 1.32 (0.29, 5.98) 0.11 (0.01, 0.99 ) φ Adjusted for; baseline age, sex, education, RDCI; province; RF positive in first year; private insurance; CDAI at visit prior to initiation Conclusion: Patient and physician related factors (location of practice) determined which advanced therapeutic was prescribed. JAKi use is increasing in ERA. Reference: [1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases Published Online First: 22 January 2020 Disclosure of Interests: Madina Weiler: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance) Amgen Canada (CATCH, clinical nurse) Abbvie (CATCH, clinical nurse) Pfizer (CATCH, Registry of biologics, Clinical nurse) Hoffman-LaRoche (CATCH) UCB Canada (CATCH, Clinical nurse) BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT) Janssen (CATCH) Celgene (Clinical nurse) Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer , Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly &amp; Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly &amp; Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB