POS0670 PATTERN OF USE OF GLUCOCORTICOIDS IN PATIENTS WITH RHEUMATOID ARTHRITIS INITIATING BIOLOGICS OR TARGETED SYNTHETIC THERAPIES IN REAL LIFE: DATA FROM BIOBADASER
Authors: I. Castrejon, L. Otero-Varela, J. M. Alvaro-Gracia, J. Calvo-Gutiérrez, C. Campos Fernández, A. García Dorta, A. Pérez Gómez, F. Sánchez-Alonso
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Glucocorticoids (GC) are frequently used as bridging therapy for rheumatoid arthritis (RA) patients starting conventional synthetic disease-modifying antirheumatic drugs (csDMARD). Both EULAR and ACR guidelines (1,2), recommend to use the lowest effective dose for the shorter duration possible, ideally less than three months. However, there are no specific recommendation of use of GC when starting or in combination with biologic or targeted synthetic therapies (b/tsDMARD). <h3>Objectives:</h3> We aim to assess GC usage after treatment initiation with bDMARDs and JAKi in RA patients in a real life multicenter cohort. <h3>Methods:</h3> Data on patients with RA switching from a csDMARD to a first biologic or JAKi enrolled in BIOBADASER 3.0 (a multicenter Spanish Registry on Adverse Events of Advanced Therapies in Rheumatic Diseases) were analyzed. Biologic treatment included TNFi, anti-IL6, anti-CD20, and CTLA4-Ig. Patients with any biologic or JAKi, all in combination with GC at therapy initiation were included. As TNFi was the larger group, a random sample was taken for comparison purposes. Descriptive statistics were used to calculate the frequency and average daily GC usage according to therapy group, both at baseline and 1 year after treatment initiation. Wilcoxon Singed Rank test was used to compare GC dose changes from baseline to 1 year after initiation of the b/tsDMARDs and ANOVA, to compare the mean dose differences across groups. <h3>Results:</h3> A total of 432 RA patients met the inclusion criteria and were included in the analysis, 78.2% women, mean age 58.4 (12.2) years old, median disease duration 5.2 years [IQR: 2.1-10.8] and mean DAS28-ESR at baseline 4.72 (1.33). Mean (SD) GC daily dose decreased from 7.6 mg (5.8) at baseline to 3.2 (5.5) mg at 1-year follow-up (Figure 1). Daily dose changes were statistically significant (Wilcoxon Signed Rank test: p &lt;0.001). Mean difference from baseline to one-year follow-up was 5.13 for TNFi, 4.59 for anti-IL6, 4.83 for anti-CD20, 4.38 for JAKi, and 2.78 for CTLA4-Ig (ANOVA: p=0.12). The proportion of patients with a decrease in GC dose from baseline to one-year follow-up after b/tsDMARD initiation was 72.7% for TNFi, 62.2% for anti-IL6, 66.7% for anti-CD20, 67.9% for JAKi, and 60.5% for CTLA4-Ig, and the proportion of patients with no GC at one year was 52.1%, 43.2%, 25.6%, 41.1% and 27.9% respectively for each treatment (Table 1). <h3>Conclusion:</h3> Our data shows that GC are frequently used and for longer than 3 months when initiating b/tsDMARDs. Around 2% of patients have GC doses over 10mg and 15% over 5mg after one year of b/tsDMARDs initiation. Further studies are necessary to evaluate variables associated with persistent use of GC. <h3>REFERENCES:</h3> [1] Smolen JS, et al. Ann Rheum Dis 2023;82:3–18. [2] Fraenkel, L. Arthritis Care &amp; Research 2021; 73: 924–939 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>