LAUSR

Biological therapies target specific pathways within the inflammatory process involved in the pathogenesis of rheumatoid arthritis. They are costly and can be associated with side-effect burden for patients. Evidence on whether medications can be stopped or tapered in stable patients in remission or very low disease activity is limited. This approach may benefit by limiting side-effects and costs. Alongside understanding the efficacy of dose tapering it is also necessary to gain insight into how patients perceive this approach. Our aim was to identify key themes that arise when patients discuss their perspective on biologic dose tapering. 213 rheumatoid arthritis patients in the Cardiff & Vale Health Board on sub-cutaneous anti-TNF agents (certolizumab, etanercept, adalimumab, golimumab) were identified. An inclusion/exclusion criterion was then formulated after consultant review to determine which patients were in remission/low disease activity and may be suitable for dose tapering. 80/213 patients qualified, and a digital questionnaire was sent to 52/80 patients where 23/52 (44% response rate) of the patients responded. The questionnaire included single and multiple response questions. Open text answers were also available if patients wanted to include any other comments. The questionnaire focused on 4 main insights: Knowledge, Experience, Perspective and Practicalities. Questionnaire data was then thematically analysed. 3 themes became prominent: [1] Hesitancy, [2] Fear, and [3] Information. [1] 83% of patients had never heard of dose tapering before the questionnaire, 61% were ‘unsure’ in their initial thoughts of dose tapering and 30% were ‘unsure’ in being considered for dose tapering. This indicates how limited understanding may contribute to patient hesitancy. [2] 18% of patients were initially ‘fearful’ and 61% of patients were afraid of ‘flaring’ again. Patients were fearful of the ‘length of time they need to wait for an appointment’ if they flared, with 57% of patients wanting ‘access to help if there was flare’. The concept of fear was multi-faceted occurring in both patients’ concerns surrounding their disease activity and practicalities related to care. [3] 35% of patients believed they did not have enough ‘information’ and 45% believed receiving more ‘information’ about tapering would make them more comfortable with the idea. The hesitancy and fear patients had may be associated with the limited exposure and information they had of dose tapering - demonstrating this initial information barrier. Patients preferred mode of contact would be virtual and face-to-face support, or just solely face-to-face. 83% of patients preferred Rheumatologists as their main source of information for dose tapering, and discussed how leaflets, case histories and websites may help in future discussions surrounding dose tapering. These patient perspectives will help us to develop and implement a dose tapering strategy for our department. Disclosure R. Rahman: None. C. Beynon: None.