Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: NICE guidelines recommend that patients with severe active rheumatoid arthritis (RA) be treated with a biologic disease‑modifying anti‑rheumatic drug as monotherapy (bDMARD mono) if they respond inadequately to 2 traditional DMARDs and are intolerant to methotrexate (MTX). Registry and healthcare utilisation data have shown that around one-third of RA patients receive their biologic treatment as monotherapy. We intended to better understand the current management of RA patients with biologics in monotherapy, particularly why patients receive monotherapy and how effective this is in daily practice.
Methods: This UK wide chart review was conducted in 26 Rheumatology Hospitals between September 2012 and May 2013 and data from 309 RA patients, who had been prescribed a bDMARD mono, were collected retrospectively. We present data from an interim analysis of 150 patients.
Results: Mean age was 62.4 yrs. and mean duration of disease was 16.3 yrs. The majority of patients were female (109). 102 (74.4%) patients were Rheumatoid factor positive (n=137) and 34 (36.6%) anti-CCP positive (n=93). With regards to past RA treatment (prior to switch to monotherapy, n=61), the most frequently used bDMARDs mono (at any time prior to switch) were etanercept (ETN; 19.3%),adalimumab (ADA; 14%), certolizumab pegol (CZP, 7.3%), rituximab (RTX, 4.7%) and tocilizumab (TCZ, 2.7%). 55 (36.7%) patients had used two or more bDMARD mono. The most frequently used traditional DMARDs (n=146) were methotrexate (MTX; 92%), sulfasalazine (74.7%) and hydroxychloroquine (42.7%).With regards to current RA treatment (all patients receiving bDMARD mono), the most frequently used bDMARDs were ETN (42.7%), ADA (26%), TCZ (10.7%), RTX (9.3%) and CZP (8%). The main reason for prescribing bDMARD mono (n=150) was unknown (88%, assumed clinician decision). Others were patient preference (6.7%) and contra-indication (7.3%). Nearly a quarter of patients were on non-NICE approved monotherapy drug and only 10.7% were in DAS28 ESR remission.
Conclusion:
Registry and healthcare utilisation data have shown that around one-third of RA patients receive their biologic treatment as monotherapy. The results of this audit draws attention to a patient population where treatment outcomes with bDMARD monotherapy are still not optimal (only 10.7% were in DAS28 ESR remission). 76.7% of the patients were treated with the above NICE approved TNF inhibitor. 55 (36.7%) patients had used two or more bDMARD monotherapies indicating that there are a significant number of patients where combination therapy with traditional DMARDs is not an option. As remission is the treatment goal and only 10.7% of patients were in remission there is an unmet medical need and therefore alternative treatment options should be explored to ensure better treatment outcomes for patients with this debilitating disease.
Disclosure:
A. J. Ostor,
None;
G. Chelliah,
Roche Pharmaceuticals,
2;
T. Dimitroulas,
Roche Pharmaceuticals,
2;
M. M. Gordon,
Roche Pharmaceuticals,
2;
N. Hewson,
Roche Pharmaceuticals,
5;
J. Mitchell,
Roche Pharmaceuticals,
5;
S. Beckley-Kartey,
Roche Pharmaceuticals,
3;
H. Pang,
Roche Pharmaceuticals,
3;
J. Saraiva-Ribeiro,
Roche Pharmaceuticals,
3.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/uk-clinical-practice-use-of-biologics-in-monotherapy-for-the-treatment-of-patients-with-rheumatoid-arthritis/