AB0434\u2005EARLY EXPERIENCE WITH JAK INHIBITOR PRESCRIBING IN THE UK: RESULTS FROM THE BRITISH SOCIETY FOR RHEUMATOLOGY BIOLOGICS REGISTER FOR RHEUMATOID ARTHRITIS (BSRBR-RA)

Abstract

Background: In 2017 a new class of oral disease modifying anti-rheumatic drugs (DMARDs), janus kinase inhibitors (JAKi), were licensed for rheumatoid arthritis (RA): baricitinib and tofacitinib. In the UK, they are approved for use in patients with high disease activity with or without methotrexate, following failure of conventional synthetic (cs) DMARDs or biologic DMARDs, the latter when rituximab is contraindicated. As a new therapy option, it is currently unclear how and when these drugs are being prescribed in patients with RA. Objectives: This analysis aims to describe the characteristics of patients starting JAKi and registered with the BSRBR-RA. Methods: The BSRBR-RA aims to capture exposure and outcome data in patients with RA receiving biologics, biosimilars and targeted synthetic DMARDs. At the start of therapy, demographic and clinical data, including past treatment data, are collected. Characteristics of all patients receiving a JAKi for the first time with data recorded in the BSRBR-RA up to 30/11/2018 are described. Results: To 30/11/2018, 443 patients in the BSRBR-RA have been treated with a JAKi; 374 patients baricitinib and 69 tofacitinib (Table). Twenty-eight percent of baricitinib and 13% of tofacitinib patients received a JAKi following csDMARDs, with no prior biologic exposure. Of these, 15% had a prior malignancy history. Of those with prior exposure, the median number of previous biologics was 3 (IQR 2-4) and 52% had received rituximab. Forty-three percent were receiving concurrent methotrexate. Conclusion: To date, more patients have been recruited starting baricitinib than tofacitinib, likely owing to the later licensing of tofacitinib. Two groups are emerging with a quarter of patients receiving JAKi immediately after csDMARDs and a majority as a later stage alternative following multiple biologics. Further recruitment and follow-up patients will allow for analysis of real-world safety and effectiveness, but differences in patient characteristics will need to be considered in any comparative effectiveness analyses. Characteristics of the first 443 patients in the BSRBR-RA treated with JAKi Ever exposed [N = 443] No biologic exposure [N = 112] Previous biologic exposure [N = 331] Baricitinib 374 (84%) 103 (28%) 271 (72%) Tofacitinib 69 (16%) 9 (13%) 60 (87%) Age (years) 61 (53 to 69) 62 (51 to 71) 61 (53 to 69) Female 335 (76%) 81 (72%) 254 (77%) Disease duration (years) 12 (6 to 21) 6 (3 to 15) 14 (8 to 22) Number of previous biologics - - 3 (2 to 4) No prior biologics1 prior biologic>2 prior biologicsUnknown 112 (25%)63 (14%)211 (48%)57 (13%) 112 (100%)--- 0 (0%)63 (19%)211 (64%)57 (17%) Type of previous biologic exposure - - - TNF inhibitorRituximabAbataceptTocilizumab ---- ---- 248 (91%)143 (52%)95 (35%)139 (51%) Concurrent Methotrexate 185 (43%) 51 (48%) 134 (42%) Concurrent oral steroids 133 (31%) 22 (21%) 111 (34%) Comorbidities# - - - None1 comorbidity2+ comorbidities 170 (38%)125 (28%)148 (34%) 58 (52%)25 (22%)29 (26%) 112 (34%)100 (30%)119 (36%) Prior Cancer 38 (9%) 15 (15%) 23 (7%) Pulmonary Fibrosis 11 (4%) 3 (3%) 8 (4%) DAS28 5.7 (5.1 to 6.4) 5.6 (5.2 to 6.2) 5.8 (5.0 to 6.6) HAQ 2 (1.4 to 2.5) 1.9 (0.9 to 2.4) 2.1 (1.5 to 2.6) Results presented as N (%) or median (IQR).#Comorbidities - hypertension, ischaemic heart disease, stroke, lung disease (asthma and COPD), renal disease, diabetes, depression, liver disease. Disclosure of Interests: Jennifer Page: None declared, Lianne Kearsley-Fleet: None declared, Rebecca Davies: None declared, Kath Watson: None declared, Kimme Hyrich Grant/research support from: Grants to institution: BMS, Pfizer, UCB, Mark Lunt: None declared