POS0478 SURVIVALTO b/tsDMARDs IN PATIENTS AFTER FULFILLING DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS CLASSIFICATION
Authors: M. Novella-Navarro, V. Ruiz, N. López-Juanes, C. A. Chacur, I. Monjo-Henry, L. Nuño, M. G. Kafati Sarmiento, D. Peiteado, A. Villalba, E. Fernández-Fernández, M. Sanz-Jardón, R. Sanmarti, C. Plasencia-Rodríguez, A. Balsa
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Since the publication of difficult-to-treat rheumatoid arthritis (D2TRA) criteria<sup>1</sup>, several studies have attempted to establish the most appropriate pharmacological and non-pharmacological strategies for the management of these patients. However, data on the treatment of choice for patients who become D2TRA are still scarce. <h3>Objectives:</h3> To evaluate the survival of different biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARD) administered after fulfilling the D2TRA criteria. To assess clinical factors related to the survival of these treatments. <h3>Methods:</h3> This retrospective cohort study included D2TRA patients according to EULAR definition. Sociodemographic characteristics, clinical and serological features and disease activity data were collected at the start of the 1<sup>st</sup> b/tsDMARD. The DAS28 was also collected at the start of the following treatment after meet D2T classification and at 6 months and patients were followed-up at least for one year. Drug retention of the subsequent line of b/tsDMARD was assessed by Kaplan–Meier plots using the log-rank test. Predictive factors affecting the discontinuation were evaluated using the univariate and multivariate analysis by the Cox proportional hazard model. <h3>Results:</h3> Of the 122 patients included, 75 maintained active treatment (61.5%) with the subsequent line after D2T compared to 37 patients (38.5%) who discontinued this treatment and required more sucessive lines of b/tsDMARDs. The treatments used after D2T were TNFi (17 patients), anti-IL6R (31 patients), abatacept (27 patients), rituximab (27 patients) and JAKi (20 patients). The mean survival of the treatments was 78.3 ± 7.6 months and the percentage of patients who maintained the treatment after D2T was 29.4% for TNFi, 29.6% for abatacept, 74.2 % for anti-IL6R, 88.9 % for rituximab and 75.0% for JAKi. Significant differences were assessed between different b/tsDMARDs (log-rank p&lt;0.01) (Figure 1). To evaluate these differences, a Cox regression was performed taking each b/tsDMARD as a reference and comparing with the others. The main differences were found between TNFi and abatacept with rituximab, meanwhile, anti-IL6R and JAKi did not show significant differences (Table 1). <h3>Conclusion:</h3> Once patients meet D2TRA criteria, the subsequent line of b/tsDMARDs with the best survival is rituximab, followed by JAKi and anti-IL6R being TNFi and abatacept the choices with leass retention rate. Moreover, the DAS28 in the first 6 months of starting the treatment after D2T was an independent risk factor for drug survival. <h3>REFERENCES:</h3> [1] Nagy G et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80:31-5. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Marta Novella-Navarro Lilly, UCB, Galapagos and Amgen, Virginia Ruiz: None declared, Natalia López-Juanes: None declared, Chafik Alejandro Chacur: None declared, Irene Monjo-Henry Lilly, UCB, Abbvie, Laura Nuño: None declared, Monica Giselle Kafati Sarmiento: None declared, Diana Peiteado: None declared, Alejandro Villalba: None declared, Elisa Fernández-Fernández: None declared, María Sanz-Jardón: None declared, Raimon Sanmarti: None declared, Chamaida Plasencia-Rodríguez Lilly, UCB, Amgen, Galapagos, Pfizer, Alejandro Balsa Roche, Lilly, Abbvie, Galapagos, UCB, Pfizer.