AB0201 CHANGES IN THE PRESCRIPTION PATTERNS OF THE SECOND-LINE BIOLOGIC AND TARGETED SYNTHETIC DMARD IN RHEUMATOID ARTHRITIS PATIENTS: 20-YEARS JOURNEY OF HUR-BIO REAL-LIFE REGISTRY
Authors: S. Kiraz, U. Kalyoncu, O. Karadag, L. Kiliç, A. Akdoğan, I. Dogan, Ş. A. Bilgen, E. Bilgin, E. C. Bolek, B. Kicasik, Y. Maraş, A. Erden, B. Armagan, A. Sari, E. Duran, B. Farisoğullari, G. K. Yardimci, Z. Özsoy, G. Ayan, M. Çalgüneri, A. İ. Ertenli
Journal: Annals of the Rheumatic Diseases (2021)

Background: In the last 20 years, anti-tumor necrosis factor (TNF) alpha agents re-designed the management of rheumatoid arthritis (RA). Despite this, unmet needs in the management of RA brought several drugs targeting different molecules and cytokines. It is still a research question that how did these developments changed daily-practice in RA patients who are intolerant/unresponsive to the first biological disease modifying anti-rheumatic drugs (bDMARD). Objectives: In this study, we aimed to explore the second 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. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) 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 776 (776/2080, 37.3%) RA patients, who was prescribed a second biological agent, was registered in HUR-BIO by the end of 2020. Of these patients, 83.7% was female. Mean age at the starting of bDMARD was 53.1 ± 13.3 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptid positivity was 69.1% and 60.5%, respectively. Distribution of first-line bDMARDs was as follows: adalimumab 194 (24.9%), etanercept 209 (26.9%), infliximab 105 (13.5%), golimumab 39 (5.0%), certolizumab 35 (4.5%), abatacept 78 (10.0%), rituximab 46 (5.9%), tofacitinib 37 (4.7%), tocilizumab 33 (4.2%). 11 (1.4%), 85 (11.0%), 282 (36.3%) and 398 (51.3%) patients were prescribed with their second 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 as second-line over time. Table 1. Distribution of second biologic DMARDs in RA patients according to 5-years periods 2001-2005 2006-2010 2011-2015 2016-2020 Total Adalimumab 3 (27.3) 15 (17.6) 69 (23.9) 77 (18.9) 164 (20.8) Etanercept 8 (72.7) 35 (41.2) 49 (17.0) 41 (10.1) 133 (16.8) İnfliximab 0 12 (14.1) 13 (4.5) 25 (6.2) 50 (5.4) Golimumab 0 0 19 (6.6) 8 (2.0) 27 (3.4) Certolizumab 0 0 2 (0.7) 26 (6.4) 28 (3.5) Anti-TNF 11 (100) 62 (72.9) 152 (53.9) 177 (44.5) 402 (51.8) Tofacitinib 0 0 4 (1.4) 73 (17.9) 77 (9.7) Tocilizumab 0 0 12 (4.2) 81(19.9) 93 (11.7) Rituximab 0 22 (25.9) 53 (18.3) 32 (7.8) 107 (13.5) Abatacept 0 1 (1.2) 61 (21.1) 35 (8.6) 97 (12.2) Non-Anti-TNF 0 23 (27.1) 130 (46.1) 221 (55.5) 374 (48.2) Total 11 (100) 85 (100) 282 (100) 398 (100) 776 (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: As the choice of second-line biologic and targeted synthetic DMARD, non-Anti-TNF bDMARDs, especially tofacitinib and tocilizumab becoming more frequent year-by-year. Despite that, anti-TNF agents as a group are still highly-prescribed options as second-line bDMARD. Disclosure of Interests: None declared