POS1368 GENDER AS A KEY FACTOR OF DELAY IN PRESCRIBING THE FIRST BIOLOGIC OR TARGETED SYNTHETIC DRUG IN PATIENTS WITH RHEUMATOID ARTHRITIS. DATA FROM BIOBADASER 3.0 REGISTRY
Authors: P. Vela Casasempere, L. Otero-Varela, S. Gómez, R. Caño, C. Campos Fernández, J. Calvo-Gutiérrez, Y. Perez-Vera, S. Manrique-Arija, S. Bustabad Reyes, F. J. Manero Ruiz, D. Ruiz-Montesino, L. Ruiz, A. Mera Varela, M. Moreno, F. Sánchez-Alonso, I. Castrejon
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Despite advances in the treatment of rheumatoid arthritis (RA), some studies continue to show an underuse of biological (bDMARDs) or targeted synthetic disease-modifying drugs (tsDMARDs) due to a variety of reasons. Among these are included factors related to patient and disease characteristics (including comorbidities, age, gender or socioeconomic status of the patient); or even difficulties in accessing b/tsDMARDs depending on the country's health system. In Spain, these treatments are fully covered by the national health system, thus eliminating the latter factor. Still, gender biases have been detected among healthcare professionals when diagnosing and treating rheumatic patients, such as the diagnostic delay in females with ankylosing spondylitis. Delays in prescribing effective drugs may result in insufficient disease control, with the subsequent progression of structural damage and disability. To date, the factors associated with prescription delay have been poorly studied. <h3>Objectives:</h3> To detect gender differences in the time course from RA diagnosis until initiation of the first bDMARD or tsDMARD, and to identify factors associated with earlier or later prescription. <h3>Methods:</h3> The study population comprises patients diagnosed with RA included in the BIOBADASER 3.0 registry, who initiated treatment for the first time with a b/tsDMARD, from 2000 to October 2022. BIOBADASER is the Spanish drug safety registry of patients with rheumatic diseases initiating treatment with any b/tsDMARD with subsequent follow-up. The timing of prescription was stratified into three periods: up to December 2006 (only three anti-TNFs marketed); January 2007-December 2016 (five anti-TNFs, abatacept, rituximab and tocilizumab, but no JAK inhibitors marketed yet); after January 2017 (JAK inhibitors and sarilumab emergence). Ratios, means and medians were used according to distribution type. Time from RA diagnosis to drug initiation was plotted using a Kaplan Meier curve, and a multivariate Cox regression model was performed to explore factors associated with disease duration until treatment start. <h3>Results:</h3> At the time of the study, 2844 patients (2229 women, 78.4%) included in BIOBADASER 3.0 had started a first b/tsDMARD. The mean age of women was lower (54.7 (SD: 12.7) vs 56.4 (SD: 11.5) years, p 0.002), while males were more likely to smoke. There were no differences in seropositivity. Figure 1 shows differences in the time course of RA between men and women. According to the Cox regression model, this gender difference is statistically significant (HR 0.89 (95% CI 0.80-0.98), p=0.016), thus the initiation of the first b/tsDMARD occurred later (longer time course of RA) in females, and also in seropositive patients, and at an older age. Conversely, therapy started earlier (shorter time course of RA) in the periods 2007 - 2016, and &gt; 2016, compared to before 2007, as well as among smokers or former smokers (Table 1). <h3>Conclusion:</h3> Over time, the prescription of b/tsDMARDs has been initiated with shorter disease duration (less advanced RA), probably due to greater confidence in the drugs and the Increasing availability of different therapeutic targets. Age, female sex, and seropositivity were associated with later prescribing, whereas smoking was associated with earlier prescribing. Further research is needed to better understand and justify these findings. <h3>REFERENCES:</h3> [1] Solomon DH, Ayanian JZ, Yelin E, et al. Use of disease-modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey. Arthritis Care Res 2012; 64:184–9. [2] Schmajuk G, Trivedi A, Solomon D, et al. Receipt of disease-modifying antirheumatic drugs among patients with rheumatoid arthritis in Medicare-managed care plans. JAMA J Am Med Assoc 2011; 305:480–6. [3] Kedra J, Granger B, Emilie S, Gaujoux-Viala C, Rat AC, Combe B, Fautrel B. Time to initiation of biologic disease-modifying antirheumatic drugs in the French cohort ESPOIR. Joint Bone Spine. 2021 Jan;88(1):105060. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Paloma Vela Casasempere Abbvie, GSK, Galapagos, Lilly, Amgen, GSK, AstraZeneca, Pfizer, GSK, Abbvie, Roche, Novartis, Lilly, AstraZeneca, Pfizer, Lucía Otero-Varela: None declared, Silvia Gómez: None declared, Rocío Caño: None declared, Cristina Campos Fernández: None declared, Jerusalem Calvo-Gutiérrez: None declared, Yanira Perez-Vera: None declared, Sara Manrique-Arija: None declared, Sagrario Bustabad Reyes: None declared, Francisco Javier Manero Ruiz: None declared, Dolores Ruiz-Montesino: None declared, Lucía Ruiz: None declared, Antonio Mera Varela: None declared, Manuel Moreno: None declared, Fernando Sánchez-Alonso: None declared, Isabel Castrejon: None declared