AB0091 DID COVID-19 PANDEMIC AFFECT THERAPEUTIC DECISION MAKING OF RHEUMATOLOGISTS? ASSESSMENT OF CHANGES OVER TIME USING JAPANESE NINJA REGISTRY
Authors: A. Ihata, A. Sekiguchi, Y. Sato, E. Ohno, E. Hashimoto, T. Matsui, S. Tohma
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> COVID-19 pandemic was world-wide disaster. Not only COVID-19 infection itself but also the risk of infection and public health policy influenced the human behavior and motivation. RA management recommendation based on robust scientific evidence is well known by all rheumatologists, however, under the pandemic of COVID-19, the therapeutic decision might become defensive. <h3>Objectives:</h3> To assess changes of therapeutic decision of bDMARDs or tsDMARDs (molecular targeted therapy (MTT)) by rheumatologists between before under COVID-19 pandemic (pandemic). <h3>Methods:</h3> NinJa is the largest RA registry in Japan. Clinical data of 15,000 over patients for 10 years from 49 hospitals in Japan were accumulated. From this database two datasets were created: from NinJa2018 to 2019 (before pandemic (BP); 12965 cases) and from NinJa2019 to 2020 (under pandemic (UP); 12195 cases). As the therapeutic decision of MTT, three options were picked up. New indication of MTT(1); the patients who have not ever used MTT were extracted from two groups(BP; 8962 vs UP; 8132 cases) and compared on the proportion of initial induction of MTT. Changes(2) or discontinuation(3) of MTT; the patients who have already used MTT were extracted from two groups and compared on the proportion of changes or discontinuation of MTT(BP; 4003 vs UP; 4063 cases). Other than pandemicc, age of onset, disease duration, sex, smoking habit, anxiety, depression, CDAI, DAS28(ESR), Boolean remission, HAQ-DI and dose of MTX and prednisolone were collected as major contributing factors in therapeutic decisions, After Fisher's exact test, multiple logistic regression analysis was performed to estimate the effect of COVID-19 pandemic on each therapeutic decision. Based on disease duration (Early; &lt;2yr, Established; 2-10yr, Long-standing; &gt;11yr), stratified analysis was also conducted. <h3>Results:</h3> (1)New indication of MTT; 5.4% of BP group and 4.3% of UP group were newly started MTT(p=0.0017). OR; 0.79 [0.69-0.92] (2)Changes of MTT; MTT were changed in 12.5% of BP group and 8.9% of UP group (p=0.00000011). OR; 0.68 [0.59-0.79] (3)Discontinuation of MTT: MTT were withdrawn in 5.4% of BP group and 5.6% of UP group (P=0.63). OR; 1.05 [0.86-1.28]. Main reasons for discontinuation were insufficiency or adverse effects of MTT. Results of multiple logistic regression analysis are shown in Table 1. Stratified Analysis: (1)Pandemic suppressed the new indication of MTT only in established RA, not in early and long-standing RA. (2)Except long-standing RA, pandemic suppressed the change of MTT in early and established RA. Pandemic did not affect the discontinuation of MTT in any subgroups. <h3>Conclusion:</h3> Under COVID-19 pandemic, the therapeutic decision on the new indication of MTT was properly made based on RA management recommendation in early RA. However, new indication of MTT in established RA and the change of MTT were significantly affected by pandemic. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>