SAT0144 DOES POLYPHARMACY IN RHEUMATOID ARTHRITIS PATIENTS AFFECT THE TREAT TO TARGET STRATEGY?
Authors: J. F. Jaramillo Gallego, J. Rosa, M. Scolnik, M. A. Tobar Jaramillo, L. Ferreyra, E. Soriano
Journal: Annals of the Rheumatic Diseases (2020)

Background: Polypharmacy (PP) is an important risk factor for drug toxicity, delirium, falls, hospitalizations and death. Patients with rheumatoid arthritis (RA) often have comorbid conditions and have PP. Treat to target strategy (T2T) implies a drug escalation and rheumatologists may not apply it in patients with PP. Objectives: Our objective was to analyze if PP affects T2T in a real-world scenario. Methods: Observational, retrospective cohort study. Patients with a new RA diagnosis (ACR/EULAR 2010 criteria) after 2010, over 18 years old, belonging to a Health Management Organization (HMO) from a university tertiary hospital, with a minimum follow-up period of 2 years, were included. PP was defined as consumption greater than or equal to 5 medications at the time of RA diagnosis, regardless of the medication used for RA, administered for a minimum period of 6 months. T2T strategy was defined as accomplished if an escalation in treatment was done when the patient had moderate or high disease activity at medical visit (by DAS28 and/or CDAI), without a significant improvement with respect to the previous visit. Prevalence of PP at RA diagnosis was calculated and RA patients were divided in those with PP at RA diagnosis time and those without. The first 2 years of disease were analyzed and compare between both groups: clinical and demographic characteristics, percentage of visits where T2T was applied, treatments received during that period. A multivariate logistic regression analysis was performed in order to identify factors associated with no T2T compliance. Results: 147 patients with RA were included, 86% women, with an average age at diagnosis of 60 years (SD: 15.8). The prevalence of PP at RA diagnosis was 12% (17 patients). Table 1 shows the comparison between patients with and without PP. Patients with PP showed a greater frequency of erosions at baseline and after 2 years of disease, a greater use of corticosteroids at 2 years, higher percentage of hospitalizations and a higher mortality. In the multivariate logistic regression analysis, no compliance of the T2T strategy was only associated with the consumption of corticosteroids at 2 years (OR: 0.36, CI95%: 0.15-0.85; p=0.019) and no association was found with PP at the beginning of the disease. Table 1. Demographic and clinical characteristics in patients with and without polypharmacy. ) Patients without Polypharmacy (n= 127 ) Patients with Polypharmacy (n= 17 ) P Male sex, n (%) 18 (13.8) 3 (17.6) 0.6 Mean age at diagnosis (SD) 58.5 (15.6) 70.6 (12.2) 0.9 Positive rheumatoid factor, n (%) 87 (66.9) 12 (70.5) 0.7 Positive anti CCP, n (%) 109 (85.8) 13 (81.2) 0.6 Erosions at baseline, n (%) 25 (19.2) 7 (41.1) 0.03 Active smoker, n (%) 28 (21.5) 3 (17.6) 0.2 Past smoker, n (%) 23 (17.6) 7 (35.2) Charlson score, median (IQR) 3 (1-4) 4 (4-5) &lt;0.0001 Polypharmacy at 2 years, n (%) 17 (13.0) 46.8 (88.2) &lt;0.0001 Rheumatological consultations in 2 years, mean (DE), (IC 95%) 8.6 (3.3) (8.0-9.2) 8.8 (3.1) (7.2-10.5) 0.6 Corticosteroid therapy at 2 years, n (%) 29 (22.3) 8 (47.0) 0.02 cDMARDs therapy at 2 years, n (%) 114 (87.6) 13 (76.4) 0.2 Biologic therapy at 2 years, n (%) 13 (10) 4 (23.5) 0.1 Erosions at 2 years, n (%) 29 (22.3) 9 (52.9) 0.007 No T2T compliance, n (%) 65 (50) 5 (29.4) 0.1 Hospitalizations, n (%) 12 (9.2) 7 (41.1) &lt;0.0001 Mortality, n (%) 2 (1.5) 2 (11.7) 0.01 Conclusion: The prevalence of PP in our patients with a new RA diagnosis was 12% and was associated with more baseline erosions, a higher consumption of steroids, and a higher frequency of hospitalizations and mortality during the first 2 years of the disease. No relationship between PP and adherence to the T2T strategy was demonstrated. In the multivariate logistic regression analysis, no compliance with the T2T strategy was only associated to the consumption of corticosteroids at 2 years, may be reflecting a poorer disease control. Disclosure of Interests: JOHN FREDY JARAMILLO GALLEGO: None declared, Javier Rosa: None declared, Marina Scolnik: None declared, Mayra Alejandra Tobar Jaramillo: None declared, LEANDRO FERREYRA: None declared, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche