AB1398-HPR RHEUMATOID ARTHRITIS– BIOLOGICAL DMARDS EXPERIENCE IN TAWAM HOSPITAL, UAE. A 2-YEAR RETROSPECTIVE STUDY

Abstract

Background Arthritis is the leading cause of disability in America, affecting 50 million adults. Although there is currently no cure for rheumatoid arthritis (RA), improved understanding of RA disease pathogenesis in recent years has led to the development of new treatments. Disease Modifying Anti-Rheumatic drugs (DMARDs) are added at early stages in the treatment of RA to suppress inflammation; they may be used as monotherapy or more commonly in combination. The treatment of RA, psoriatic arthritis (PSA) and ankylosing spondylitis (AS) is aimed at achieving the lowest disease activity and remission. Patient compliance is considered necessary for the success of treatment in chronic diseases. Objectives The objective of this study was to assess the patient adherence to their medications and clinic visits in addition to assessing the prescribing, screening and monitoring parameters of biological disease DMARDs according to the care pathway at Tawam Hospital and EULAR recommendations. Methods A retrospective observational review using data from the computer based system at Tawam hospital. All adult patients with RA, PSA and AS starting a biological DMARD during our study period; December 2016 to December 2018 were eligible. Results A total of 54 patients were included. Eighty percent were females. Sixty three percent RA patients, 24% PSA patients and 13% AS patients. Indication, dosing and blood monitoring criteria were met for 100% of the patients. Vaccination criteria was met in only 20%. Screening criteria was met by 57%. Ninety two percent of the RA and PSA patients were started on methotrexate for 3 months before biologics initiation as per guidelines. Forty three percent of AS patients used 2 non-steroidal anti-inflammatory drug before starting biological therapy. Medication adherence was measure by; the duration of therapy, consistent clinic visits and regular medication refills. Eighty four percent of the total number of patients had a duration of therapy for 6 months or more. Twenty six percent were consistent with their monthly clinic visits. Sixty one percent were compliant with their monthly medication refills. RA patients were further analysed as they made the majority of our patients. Ninety seven percent of the RA patients had a baseline DAS documented. Eighteen percent had a baseline of DAS28 3.2. Twenty nine percent had a baseline DAS28>5.1.Three percent of the patients started on a biologic with no baselines DAS. One hundred percent of the patients were started a biological DMARD including the 18% that had DAS28≤2.6; however the reasons were clearly stated (example of reasons, contemplating pregnancy, adverse reaction to previous treatment). The DAS 28 was documented again at the end of the study period. Fifty nine percent of the patients had DAS28 3.2 and three percent of the patients had a DAS28>5.1. All the patients with DAS28>3.2 (15%) changed their treatment regimen. Conclusion This audit concluded 100% compliance with the care pathway at Tawam Hospital and EULAR recommendations in the treatment of RA, PSA and AS with regards to starting a biologic treatment, switching treatment, dosing and monitoring. Overall the patients adherence to their clinic visits and medication refills was satisfactory; however improving adherence to therapy could therefore dramatically improve the efficacy of drug therapy. However there was a gap in the vaccination and screening parameter which indicates a need to add a tool in computer system to aid the physicians in fulfilling this gap.