AB0665 SWITCHING INTRAVENOUS ABATACEPT AND TOCILIZUMAB TO SUBCUTANEOUS INJECTIONS DURING THE COVID-19 PANDEMIC: A FRENCH EXPERIENCE
Authors: A. Combier, S. Wanono, L. Poiroux, C. Frantz, E. Descamps, O. Fogel, M. Boisson, X. Ayral, C. Bottois, Y. Allanore, J. Avouac
Journal: Annals of the Rheumatic Diseases (2021)

Background: The COVID-19 pandemic requires measures to reduce patient exposure to the risk of contamination, in particular by limiting hospital admissions and promoting lockdown. In order to respond to these healthcare measures, patients were offered to replace intravenous infusions (IV) of abatacept (ABT) and tocilizumab (TCZ) to subcutaneous injections (SC). Objectives: To assess the outcome of patients who switched from IV ABT or TCZ to SC during the COVID-19 pandemic. Methods: A survey was conducted in December 2020 in partnership with the national AFP-RIC patient association to assess the outcome and satisfaction of patients who switched from ABT or TCZ IV to SC during the first wave of COVID-19 pandemic. We also analysed the outcome of patients who switched from IV ABT or TCZ to SC in the rheumatology department of Cochin Hospital during the lockdown in April/may 2020. Articular activity parameters (swollen joint count, pain joint count, visual analogic pain scale, CRP, DAS-28 activity score) were assessed at medical visits before and 6 months after switching from IV to SC. The data collected from the AFP-RIC patient association and the rheumatology department of Cochin Hospital were then aggregated and analyzed by Chi-square and Wilcoxon tests. Results: 81 patients responded to the survey carried out by AFP-RIC patient association, including 29 treated with IV ABT (n=15, 52%) or TCZ (n=14, 48%). 17/29 (59%) were offered to switch from IV to SC, 14/17 patients (82%) accepted and 7 patients were still receiving ABT or TCZ SC injections in December 2020. In the rheumatology department of Cochin hospital, 71 patients were scheduled in April/May 2020 to receive IV ABT or TCZ, and 27 (38%) switched to SC. After 6 months, 19 patients (70%) had maintained SC injections, were satisfied with this injection route of administration and their articular activity parameters were unchanged (Table 1). Table 1. Course of Disease parameters evaluated in the 19 patients who maintained abatacept or tocilizumab SC injections in the Rheumatology department of Cochin Hospital Parameter, mean(SD) Inclusion visit Switch to SC (n=19) 6 month visit (n=19) P-value DAS28 2.3 (1.2) 2.3 (0.7) 0.62 Tender joint count 2.5 (3.5) 1.3 (1.7) 0.49 Swollen joint count 1.3 (2.5) 0.9 (0.6) 0.35 Patient Global Health (cm) 3.2 (1.9) 2.6 (1.8) 0.60 CRP (mg/L) 3.2 (4.1) 5.2 (4.9) 0.56 CRP: C-Reactive Protein, SD: Standard Deviation The combined analysis of these two populations included 41 patients (33 rheumatoid arthritis, RA, 7 juvenile idiopathic arthritis, JIA and 1 polymyalgia rheumatica) who switched to SC ABT or TCZ. 26/41 (63.5%) patients maintained SC injections and IV was re-established in 15/41 (36.5%). Reasons for returning to IV were poor tolerance of SC injections (n=6, 40%), worsening symptoms (n=11, 73%), patient preference to see a rheumatologist in hospital (n=10, 67%) and the high number of SC injections (n=2, 13%). The proportion of patients returning to IV was higher in RA patients compared to patients with JIA (42% vs. 14%, p = 0.08). Age and disease duration were not significantly different between patients who maintained SC injections and those who returned to IV (respectively p=0.97 and p=0.63). Conclusion: Our study suggests that switching from IV ABT or TCZ to SC is an acceptable procedure during the COVID-19 pandemic, especially for patients with JIA. Acknowledgements: Association AFP-RIC (Angélique Hochedé, Cyrielle Beller, Sandrine Rollot) and the members of the association for their help in the conduction of the survey Disclosure of Interests: None declared.