POS0069 GLOBAL DISPARITIES IN THE TREATMENT OF RHEUMATOID ARTHRITIS IN DIFFERENT REGIONS OF THE WORLD: ANALYSIS OF RESULTS FROM THE INTERNATIONAL COVAD-2 STUDY
Authors: N. Ziade, I. Hmamouchi, M. Moussallem, B. Salameh, P. Yaadav, E. Nikiphorou, I. Parodis, A. Makol, T. Velikova, M. Milchert, J. Day, R. Aggarwal, V. Agarwal, L. Gupta
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The treatment of patients with rheumatoid arthritis (RA) has become standardized and targeted in the past decades, using novel disease-modifying anti-rheumatic drugs (DMARDs: biologic (bDMARDs) and targeted synthetic (tsDMARDs)), which resulted in a significant improvement in the disease prognosis. However, treatment patterns might vary around the world according to different patient profiles, medical practices, and socioeconomic considerations. <h3>Objectives:</h3> To assess worldwide disparities in different DMARDs, with a focus on novel therapies, in patients with RA from the COVAD2 study, taking into account the geographic location and the country's socioeconomic level. <h3>Methods:</h3> Data on RA patients was extracted from the COVAD2 database, an international multi-centre cross-sectional study based on a patient self-reported online study on patients with autoimmune diseases and controls from 110 countries. Sociodemographic data were collected, and regions of the world were considered in 5 categories: Africa, Asia, Europe, North America grouped with Oceania (due to the low number in the latter), and South America. The Human Development Index (HDI) was used to evaluate the country's economic level. Pain, Patient-Reported Outcome Measurement Information System (PROMIS) scores, Physical function, and Fatigue 4a were recorded. Finally, DMARDs were categorized as corticosteroids, conventional synthetic (cs)DMARDs, Immunosuppressives, Hydroxychloroquine, bDMARDs (TNFi, IL1i, IL6i, IL12-23i, IL17i, IL23i, RTX, Belimumab, CTLA4Igi) and tsDMARDs (JAKi). The distribution of novel therapies (bDMARDs and tsDMARDs) was evaluated by continent and HDI. Factors associated with the novel therapies were identified using Chi-Square, Fisher exact test, and ANOVA as appropriate in a bivariate analysis, and significantly associated variables (p&lt;0.05) were included in a multivariable binary logistic model. <h3>Results:</h3> At the time of the analysis, the COVAD2 database comprised 10739 participants, including 6390 patients with autoimmune rheumatic diseases and 2007 with RA. In patients with RA, the mean age was 51±14 years, disease duration was 12±10 years, 88% were females, 21% were in disease remission, and 32% had two or more comorbidities. Among all patients with RA, 39% were from Europe, 25% from Asia, 15% from North America and Oceania, 12% from South America and 9% from Africa, with significant differences in age, gender, disease duration, activity, multimorbidity and PROs among the continents. In parallel, 61% were from countries with very high HDI, 24% from high, 13% from moderate and 2% from low HDI. The use of novel therapies was reported in 30% of all patients with RA and was the highest in Europe (44%), followed by North America and Oceania (34%), South America (31%), Asia (12%), and Africa (5%) (p&lt;0.001) (Table 1). Also, it increased with HDI (3% in low, 6% in Medium, 21% in high and 39% in very high HDI countries (p&lt;0.001)). After adjusting on age, disease duration, gender, ethnicity, continent, HDI, pain, disease activity, basic multimorbidity, PROs, the use of novel therapies remained associated with the continent, the country's HDI, and longer disease duration. <h3>Conclusion:</h3> In patients with RA from the COVAD2 international database, the use of novel DMARDs varied significantly across continents and increased significantly with the country's economic level. These global disparities in RA treatment, beyond patients' and disease's characteristics, should be addressed to ensure equitable access to effective healthcare interventions around the world. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>