AB0641 DEMOGRAPHIC CHARACTERISTICS, COMORBIDITIES AND TREATMENT CHOICES OF EARLY AND LATE ONSET RA PATIENTS: RESULTS FROM E.PULSE, THE NATIONWIDE HEALTH DATA
Authors: O. Küçükşahin, H. Satiş, E. Karabulut, G. Ayan, A. Erden, E. Bilgin, B. Armagan, D. Tecer, H. Babaoglu, A. Sari, L. Kiliç, S. Birinci, M. Caglayan, M. M. Ulgu, M. O. Ayvali, N. Ata, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a very heterogeneous disease and may show different clinical course according to age group. Therefore, studying treatment choices according to age groups in a nationwide database may add important information. <h3>Objectives:</h3> In this study, it was aimed to evaluate the differences in demographic characteristics, co-morbid diseases and treatment choices of RA patients at the nationwide health data. <h3>Methods:</h3> <i>Data and Patient Selection:</i> This nationwide cohort study utilized information from the Turkish Ministry of Health National Electronic Database, E-Pulse. The Ministry of Health employs Big Data technology for service delivery, incorporating integrated systems like E-Pulse and the National Healthcare Information System (NHIS). E-Pulse houses clinical records for over eighty million individuals in Turkey, capturing demographic details, laboratory results, drug history, and comorbidities since 2016. In this analysis, cases of rheumatoid arthritis (RA) were identified using ICD-10 codes M05 ('M05.0', 'M05.1', 'M05.2', 'M05.3', 'M05.8', 'M05.9') and M06 ('M06', 'M06.0', 'M06.1', 'M06.2', 'M06.3', 'M06.4', 'M06.8', 'M06.9') twice, with at least 30 days apart, and with at least one prescription for a disease-modifying antirheumatic drug (DMARD). Cases with spondyloarthritis and/or psoriatic arthritis ICD codes were excluded. Data recorded in the E-Pulse system between January 2016 and December 2022 were utilized for this study. <i>Definitions</i>: The age of the patients at the time of initial presentation was recorded. Patients were analysed in two subgroups. Firstly, those aged &gt; 65 years were grouped as late-onset RA (LORA) and those aged &lt; 65 years were grouped as early-onset RA (EORA). Demographic characteristics, co-morbid diseases, treatment choices according to the two groups. <h3>Results:</h3> Overall, 347.902 (79.5% female) RA patients registered in the E-Pulse data were analysed. The median age of all, LORA and EORA were 56 years (1-107), 71 (65-107), 51 (1-64) respectively. 90,687 (26.1%) patients were older than 65 years of age when they were first registered in the E-Pulse system. <i>Co-morbidities of LORA vs EORA;</i> Associated auto-immune diseases were less common in LORAs: (Sjogren syndrome 3.9% vs 5.8%, OR 0,66 (0,64-0,69), SLE 1.0% vs 3.6%, OR 0,28 (0,26-0,29), SSc 0.9% vs 1.3%, OR 0,65 (0,60-0,70)). The other comorbidities were LORA vs EORA: Cancer 8.2% vs 4.3%, OR 1,98 (1,92-2,04), DM 23.4% vs 14.2%, OR 1.85 (1.81-1.88), HT 83.3% vs 45.6%, OR 5,94 (5,83-6,06), hyperlipidemia 23.8% vs 12.5%, OR 2.19 (2.15-2.32), thrombosis 4.4% vs 2.4%, OR 1,88 (1,80-1,95), PTE 1.1% vs 0.5%, OR 2,34 (2,15-2,54), aneurysm 0.7% vs 0.3%, OR 2,24 (2,02-2,49), COPD 14.6% vs 4.3%, OR 3.82 (3.72-3.92), ILD 1.4% vs 0.6%, OR 2,41 (2,24-2,59), chronic renal failure 6.1% vs 2.1%, OR 3,09 (2,98-3,22), total hip prosthesis 1.3% vs 0.9%, OR 1,47 (1,37-1,57), total knee prosthesis 7.3% vs 3.3%, OR 2,34 (2,26-2,41) and mortality 23.6% vs OR 4.0%, 7,48 (7,30-7,67). <i>Treatment choices of LORA and EORA:</i> Among synthetic DMARDs, methotrexate (50.1% vs 58.0%), sulfasalazine (28.3% vs 32.6%) and hydroxychloroquine (56.9% vs 64.6%) were less preferred in geriatric age group, while leflunomide (37.7% vs 32.0%) was used slightly more frequently. The use of bDMARDs, bDMARD switch, were significantly less in the geriatric age. Relatively, abatacept and rituximab were preferred more than other bDMARDs in the geriatric age (Table 1). <h3>Conclusion:</h3> In conclusion, RA in geriatric age includes approximately one quarter of all patients and the comorbid conditions accompanying them probably influence their choice of treatment. As expected, co-morbid conditions accompanying RA patients include metabolic diseases, thrombosis, cancer, chronic kidney and chronic lung diseases, which increase with age. Both synthetic and b/tsDMARDs were less favoured in geriatric age. Importantly, abatacept and rituximab were preferred slightly more frequently in geriatric age, which may be related to safety profile or ease of administration. <h3>REFERENCES:</h3> <b>NIL.</b> <b>Table 1.</b> Distribution of DMARDs used according to age group at first presentation <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>