AB0400 FREQUENCY OF BIOLOGIC/SMALL MOLECULE MONOTHERAPY FOR RHEUMATOID ARTHRITIS IN THE EU: REAL-WORLD EVIDENCE FROM A PATIENT AUDIT STUDY

Abstract

Background Biologic/small molecule therapy has been the standard of care for adult patients diagnosed with rheumatoid arthritis (RA) who have failed conventional DMARD therapy, resulting in familiarity, comfort, and satisfaction among physicians. Prior recommendations of combining biologics/small molecules with a DMARD like methotrexate (MTX) have recently been challenged by clinical data demonstrating the effectiveness of IL-6 and JAK inhibitors as monotherapy. Objectives This research sought to evaluate the frequency of biologic/small molecule monotherapy regimens among European RA patients who were recently switched from one biologic/small molecule to another. Methods An independent market analytics firm collaborated with rheumatologists in France (n=62), Germany (n=66), Italy (n=61), Spain (n=68) and the UK (63) to conduct an online retrospective chart review of RA patients who had switched treatment from one biologic/small molecule to another in the prior twelve weeks. Rheumatologists were able to submit up to seven RA patient charts. A total of 1,312 patient charts were collected via a market-specific compliant audit form in September 2018 and included patient and physician demographics, patient treatment history, and clinical/non-clinical patient parameters. Results Overall, the analysis of patient chart audits revealed that 22% of all recently switched patients were switched to a biologic/small molecule monotherapy regimen. The frequency of monotherapy was highest in Germany (32%) and lowest in the UK (13%). Monotherapy was more frequent for patients switched to infliximab (39%) and tofacitinib (39%) and lowest for those switched to tocilizumab IV (12%) and rituximab (11%). When combined into classes of agents, frequency of monotherapy among recently switched patients was 25% for TNFs, 24% for JAK inhibitors, 23% for IL-6 inhibitors, and 16% for non-JAK/IL-6 AMOAs (abatacept or rituximab). On a country-specific level, rates of TNF monotherapy were highest in Germany (38%) and lowest in the UK (16%). IL-6 monotherapy was also more common in Germany (27%) but least common in France (17%). JAK monotherapy was highest in France (34%) and lowest in the UK (7%), while monotherapy for abatacept/rituximab was highest in Germany (32%) and again lowest in the UK (13%). Conclusion The popularity of biologic/small molecule monotherapy varies by EU5 country and while rates are highest for TNF inhibitors, use of biologic/small molecule monotherapy for patients recently switched to a JAK or IL-6 inhibitor are comparable. Disclosure of Interests None declared