AB0715 CHANGES IN PRESCRIBING PATTERNS AND MORTALITY OF RA PATIENTS TREATED WITH bDMARDs AND tsDMARDs IN THE 21ST CENTURY
Authors: E. Fernández Panadero, A. Fernández Reboul Fernández, J. L. Rodas Flores, G. Moral García, B. Hernández-Cruz, J. J. Pérez Venegas
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The arrival of bDMARDs and tsDMARDs almost 25 years ago has revolutionized the management of RA. Treatment guidelines focus on T2T strategy and remission as a treatment goal <sup>1</sup>. However, they are conditioned by numerous variables, including health systems, costs, patient characteristics and comorbidities <sup>2</sup>. This has led to a change in prescription patterns in recent years<sup>3</sup>. On the other hand, although more evidence is still lacking as to whether mortality has been modified by improved therapeutic management, it has been suggested that pulmonary involvement may have overtaken cardiovascular disease as the main factors contributing to mortality<sup>4</sup>. <h3>Objectives:</h3> To determine the prescribing patterns of bDMARDs and tsDMARDs, as well as the associated mortality and its causes in patients with RA treated at a university hospital in southern Spain. <h3>Methods:</h3> This is a retrospective observational study in which the electronic medical records of all patients diagnosed with rheumatoid arthritis (according to EULAR/ACR 2010 criteria) who received at least two doses of the DMARD from January 2017 to December 2022, and who continued follow-up until October 2023, were analyzed. Sociodemographic, clinical and RA variables were collected. Descriptive statistics and mortality rates were used. <h3>Results:</h3> A total of 340 patients were included, 79% women aged 46.3 ± 12.6 years; 87% RF+, 83% ACPA+, 61% with erosions, weighing 71 ± 1.3 kg, 1.60 ± 0.8 m in height and BMI of 28.2 ± 5.4. Of these, 43% had extra-articular manifestations (ILD 15%, secondary Sjögren syndrome 19%, rheumatoid nodules 10%, carpal tunnel 7%, bronchiectasis 4%, uveitis/episcleritis 2% and others with frequency less than 1% (pleural effusion, pericarditis, rheumatoid vasculitis or Felty's syndrome). The associated comorbidities were: osteoporosis 28%, osteoporotic fracture 14%, fibromyalgia 33% and depression 32%. Patients received 380 lines of treatment; 193 (51%) 1st line, 89 (24%) 2nd line, 59 (16%) 3rd line and 34 (10%) 4th line or greater. The time with the treatment was 4.4 ± 3.7 years. In the 1st line, the most prescribed drugs were Anti-TNF in 126 (65%) patients, with 87% biosimilars, followed by Anti-CD20 (biosimilar rituximab) in 19 (10%) and JAK inhibitors in 18 (9%), abatacept in 16 (8) and Anti-IL6 in 14 (7%). In the 2nd line, the most prescribed drugs were JAK inhibitors in 30 (33%), followed by Anti-TNF in 22 (25%) with 82% biosimilars, abatacept in 15 (17%), anti-CD20 in 14 (16%) and AntiIL6 in 8 (9%). In 3rd line, JAK inhibitors were the most prescribed in 22 (37%) cases, followed by anti-CD20, anti-TNF, and abatacept with 10 (17%) patients in each group and anti-IL6 in 7 (12%). The use of glucocorticoids increased according to the line of treatment by 63%, 79% and 82% in 1st, 2nd and 3rd line; while the use of conventional DMARDs remained relatively stable at 58%, 49%, and 41%, respectively, most cases with MTX (75%). The DAS28 baseline was 4.2 ± 1.24 and the final DAS28 was 2.6 ± 1.3. A line change occurred in 147 (38%) cases due to inefficiency (secondary failure in 28% and primary failure in 13.9%); adverse events in 27%, and other causes such as patient desire, pregnancy, and remission in 37%. A total of 19 (5%) deaths (95% CI, 3.3-8.5) were recorded, which constitutes a mortality density of 11.3 per 1,000 patient-years (95% CI, 6.9-18.2). The causes of mortality were complications of ILD/respiratory failure in 7, neoplasia in 4, sepsis in 3, myocardial infarction 2, pulmonary thromboembolism 1, Covid 1 and unknown cause in 1 patient. <h3>Conclusion:</h3> Prescription patterns for advanced therapies have changed in the last 6 years, with greater use of anti-TNF biosimilars and JAKi inhibitors compared to previous cohorts. Causes of mortality have also changed, with a predominance of those associated with ILD, with no increase in mortality rates. <h3>REFERENCES:</h3> [1] Smolen J, et al. Ann Rheum Dis. 2023 Jan;82(1):3-18. [2] Taylor P, et al. Ther Adv Musculoskelet Dis. 2022 Aug 16;14:1759720X221114101. [3] Hernández-Cruz B, et al. Arthritis Res Ther. 2016 Nov 8;18(1):259. [4] Black RJ, et al. Rheumatology (Oxford). 2023 Nov 2;62(11):3576-3583. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>