Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Prescribing biologics for patients with rheumatoid arthritis (RA) may be restricted by many factors other than the physician’s clinical judgment. In Kuwait, patients with RA have a free and a rapid access to biologics as they are provided within a week after being prescribed by their treating rheumatologists. The cost of treatment is fully covered by The Ministry of Health for Kuwaiti patients (KP) while non-Kuwaiti patients (NKP) have to follow a strict and a long protocol and if approved, biologic treatment will then be partially covered by a charity organization. The purpose of this study is to evaluate whether accessibility to treatment affects the rate of biologic prescription and whether this has an impact on disease activity and quality of life in patients with RA.
Data were extracted from The Kuwait Registry for Rheumatic Diseases (KRRD). Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. All KP were selected. Demographic data, treatment agents, disease activity tools and HAQ-DI scores were studied and were compared with NKP using appropriate statistical methods.
A total of 1,511 RA patients were included with 7,893 hospital visits. 795/1,511 (52.6%) were KP. Among KP 555/795 (69.8%) were females with a mean age of 54.5+13 years and a disease duration of 8.9+7.5 years (0-52). 73.5% had a positive rheumatoid factor and 58.9% had positive anti-citrullinated protein antibodies. 446 (56.1%) were on methotrexate and 53 (6.7%) were on steroid therapy. 389/795 (48.9%) were on biologic treatment, and 124/389 (31.9%) used them as monotherapy. For the total KP the mean values for DAS28 was 2.67+1.2, CDAI 4.03+5.6, SDAI 7.75+5.4, VAS pain 1.67+2.4, tender joints 2.95+5.5, swollen joints 0.41+1.8, ESR 28.4+22.4, CRP 5.52+4.9 mg/dL and HAQ-DI 0.88+0.77. Comparing KP with NKP, NKP had lower prescription for biologic therapy (8.9% vs 48.9%, p<0.001, higher methotrexate (74.9% vs 56.1% p<0.001) and higher steroid therapy (14% vs 6.7%, p<0.001). With regard to RA activity, NKP had higher DAS28 (p=0.004), higher ESR (p=0.014), more swollen joints (p<0.001) and higher HAQ-DI (p<0.001).
In the setting of easy accessibility to treatment, biologics were prescribed by rheumatologists in a much higher rate than when approval is preceded by a strict and a long protocol. This may explain the lower disease activity and the lower rate of steroid use and its positive impact on physical function.
To cite this abstract in AMA style:Al-Herz A, Saleh K, Al-Awadhi A, Al-Kandari W, Hasan E, Ghanem A, Ali Y, Alhajeri H, Hayat S, Aldei A, Hussain M, Nahar I, Abutiban F, Alenizi A, Mokaddem K, Khadrawy A, Fazal A, Zaman A, Mazloum G, Bartella Y, Hamed S, Alsouk R, Al-Saber A. Easy Accessibility of Biologics and Its Impact on Disease Activity and Quality of Life in Kuwaiti Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/easy-accessibility-of-biologics-and-its-impact-on-disease-activity-and-quality-of-life-in-kuwaiti-patients-with-rheumatoid-arthritis/. Accessed October 23, 2020.
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