AB0658 TWO-YEAR PERSISTENCE OF FIRST-LINE BIOLOGICAL OR JAK INHIBITOR TREATMENT IN PATIENTS WITH LONG-STANDING RHEUMATOID ARTHRITIS AND FAILURE TO TRIPLE THERAPY WITH SYNTHETIC DMARDs
Authors: S. Ibáñez, D. García, M. P. Poblete, F. Valenzuela, M. Canals, C. Jaque, M. Armstrong, O. Valenzuela
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In Chile, since 2016, patients with rheumatoid arthritis (RA) can apply to receive state-funded biological or JAK inhibitor treatment if they have failed (defined as a DAS28-ESR persistently greater than 5.1) to the combination of three synthetic DMARDs (including methotrexate, leflunomide, sulfasalazine, and/or hydroxychloroquine), used for at least 6 months. <h3>Objectives:</h3> Our objective was to evaluate the two-year persistence of the first biologic or JAK inhibitor used in this group of patients, and the factors associated with it. <h3>Methods:</h3> We conducted a retrospective evaluation of patients benefiting from state-funded biological or JAK inhibitor treatments at two healthcare centers. Demographic variables were recorded, including gender, age, work status, smoking status, comorbidities (Charlson Comorbidity Index), presence of rheumatoid factor and/or anti-citrullinated peptide antibody, years since RA diagnosis, synthetic DMARDs used at the time of starting biological or JAK inhibitor treatment, use of corticosteroids and NSAIDs, the specific biological or JAK inhibitor used, persistence with the medication after two years, and, for those who discontinued treatment, the cause of discontinuation and duration of persistence. The relationship between persistence and different demographic and baseline variables was evaluated using logistic binary regression. <h3>Results:</h3> We included 210 patients, of whom 184 were women (87.6%). The median age was 61 years (IQR 53-68), and the Charlson Comorbidity Index was 3 or higher in 60% of patients. The median baseline DAS28-ESR was 5.99 (IQR 5.4-6.69), and the median years since diagnosis was 9.1 (IQR 5.1-16.6). Table 1 shows the baseline characteristics of persistent and non-persistent patients at two years, including the distribution of use of traditional synthetic DMARDs, biologicals, and JAK inhibitors. At the two-year mark, 116 patients (55.3%) persisted with the first-line biologic or JAK inhibitor. Among the 94 patients who discontinued treatment, the mean duration of persistence was 341 days (SD 174). The univariate analysis revealed significant associations between persistence and the baseline use of sulfasalazine (p=0.015) and hydroxychloroquine (p=0.21). In the multivariate analysis (adjusted for age, sex, work status, smoking status, Charlson Comorbidity Index, seropositivity, use of NSAIDs, corticosteroids and synthetic DMARDs, and biological or JAK inhibitor used) only baseline use of sulfasalazine continued to have a statistically significant association with persisting at 2 years with the first biological or JAK inhibitor used (p=0.03; OR=2.13; 95% CI 1.08-4.2). The primary cause of treatment discontinuation was loss of efficacy (60.6%), followed by adverse effects (35.1%). <h3>Conclusion:</h3> The two-year persistence rate of the first biologic or JAK inhibitor in this group of patients with long-standing rheumatoid arthritis, high comorbidity index, and failure of synthetic DMARDs triple therapy was low, at only 55.3%. The association between greater persistence and the initial use of sulfasalazine should be explored in future studies. Notably, the utilization of JAK inhibitors as first-line advanced therapy was very low. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Sebastián Ibáñez Fresenius Kabi, Novartis, Abbvie, Janssen, Fresenius Kabi, Novartis, Abbvie, Janssen, Fresenius Kabi, Novartis, Abbvie, Janssen, Dominga García: None declared, María Paz Poblete: None declared, Francisca Valenzuela: None declared, Magdalena Canals: None declared, Carla Jaque: None declared, Macarena Armstrong: None declared, Omar Valenzuela: None declared.