LAUSR

Background Several biological DMARD (bDMARD) therapies have been approved for use in rheumatoid arthritis (RA) and are classified according to their respective therapeutic target: Anti TNF therapies and non-Anti TNF therapies. They are very effective in most of patients but their comparative efficacy in daily clinical is less well known. Objectives Our aim was to compare the efficacy of anti-TNF therapies vs non-Anti TNF therapies in a cohort of Colombian RA patients followed in different arthritis clinics under daily clinical practice conditions. Methods We conducted a cross-sectional study including with RA patients treated at Medicarte IPS from March 2009 to December 2016. Medicarte is a referral center for the integral medical care and pharmaco-surveillance of patients under biologic therapies in 13 cities in Colombia for inflammatory arthropathies, mainly RA, psoriatic arthritis and spondyloartropathies. Clinical information was obtained from electronic clinical records and medical claims. Only those patients with disease activity scores (DAS-28) at baseline and at the last visit were included. Remission was defined as DAS-28 <2.6 on the last visit. Patients treated only with conventional DMARD and/or tofacitinib were excluded. Results A total of 1,020 patients with RA were identified. 844 patients (88% female) were included in the final analysis, 416 patients with anti TNF and 428 with non-anti TNF therapies (Rituximab 199, Tocilizumab 125 and Abatacept in 104 patients). The mean age was 55.2±11.8 years, with a mean disease duration of 15.2±9.5 years. bDMARD therapy was used for a mean time period of 3.2±2.5 years. Eighty three percent of patients were treated in combination therapy and 80% of patients were seropositive (CCP and/or RF). Both groups did not differ significantly on baseline clinical characteristics (see Table), with 2 exceptions: patients who received Anti-TNF therapies were treated more frequently as first line therapy (75.2% vs 53.2%, p<0.001) and received in a higher proportion combined therapy (90.9% vs 75.0%, p<0.001). A total of 59% of patient achieved remission at the last visit. Three year remission rates were slightly higher but not significant in patients treated with non-anti TNF therapies vs anti-TNF therapies (59.6% vs 53.3%, p=NS). We did not find significant differences in remission rates according serological status.Table 1. General Characteristics of patients with RA under bDMARD therapy Total Anti TNF Non-Anti TNF p value N=844 N=416 N=428 Gender (female) % 88.0 88.7 87.6 NS Age (years, SD) 55.2±11.8 55.0±11.8 55.4±11.8 NS Disease duration (years, SD) 15.2±9.5 15.0±9.9 15.5±9.0 NS bDMARD therapy duration (years) 3.2±2.5 3.2±2.5 3.2±2.4 NS First line bDMARD therapy,% 64.0 75.2 53.2 p<0.001 Combined therapy, % 83.0 90.9 75.0 p<0.001 Seropositive (either CCP and/or RF) % 80.1 82.0 78.3 NS DAS-28 at baseline (± SD) 4.3±1.1 4.20±1.14 4.4±1.21 NS HAQ at baseline (± SD) 1.13±0.77 1.09±0.78 1.16±0.77 NS Conclusions In real-life setting, a meaningful proportion of RA patients achieved remission on the last visit. Patients treated with anti-TNF and non-anti TNF therapies had similar baseline characteristics and after a mean time period of treatment of 3 years, achieved similar remission rates. Disclosure of Interest None declared