E. Castillo

SAT0242 Effectiveness of conventional dmard therapy in patients with rheumatoid arthritis treated under a treat to target model – lessons from a real-life cohort

Background: Rheumatoid arthritis (RA) is a common chronic inflammatory disease. It is characterized by progressive, joint damage, impaired joint function and pain, the disease causes disability and reduces quality of life. Treat-to-target (T2T) is an acknowledged management strategy for RA; it proposes that the therapeutic target in RA should be a state of remission or low disease activity. There are two types of pharmacological therapy available: biological DMARDs that are considered highly expensive for our countries and conventional DMARDs which have demonstrated effectiveness and is a low-cost treatment (1,2). Objectives: The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using a T2T strategy during three years in a cohort of patients receiving conventional DMARDs. Methods: A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015–2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Clinical follow-up was according to DAS28: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient’s conditions don’t permit it; We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients reached LDA or REM. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We analyzed normality for DAS28, in order to compare disease activity at beginning and the end of follow-up. Results: During 3 years we included 1953 patients were 39% were in low disease activity, 47% in moderate disease activity and 14% were in severe disease activity, 84% were female, mean age was 60 years±12. At baseline mean DAS28 was 4.45±0.90 with a median of 4.3 at three years the mean DAS28 was 3.83±1.08 with a median of 3.60. At the end of follow-up 46% of population achieved remission and 25% achieved low disease activity; at overall 71% improved disease activity, see table 1. In our study DAS28 was not normally distributed, thus we performed a Wilcoxon test in order to compare the mean DAS28 at baseline/36 months showing statistical significance (P<0.05). ACTIVITY LEVEL BASELINE 3 YEARS FOLLOW-UP n % n % REM 898 46 LDA 759 39 488 25 MDA 912 47 528 27 SDA 282 14 39 2 Conclusions: Patients treated with conventional DMARD therapy and under a T2T model achieve favorable results in regards of disease activity. This is real life evidence that can support the advantages of treating RA patients with a multidisciplinary team under a T2T model with a low-cost treatment. References [1]Aletaha D, Alasti F, Smolen JS. Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Annals of the Rheumatic Diseases2015. [2]Ahsan T, Erum U, Khowaja D, Dahani A. Delayed conventional DMARDs therapy is effective in Rheumatoid Arthritis. Pakistan journal of medical sciences2017;33(4):840–3. Disclosure of Interest: None declared

SAT0131 A Look To The Wrong Diagnosis of Rheumatoid Arthritis

Background There is a lack of expertise in rheumatoid arthritis (RA) diagnosis in primary level of Colombian medical centers, leading to misdiagnosis; many times osteoarthritis (OA) and another rheumatic diseases are misdiagnosed as RA which derives in wrong treatment for patients with clinical and health economics implications. Objectives The aim of this study was to describe demographic and clinical characteristics of a cohort of patients with misdiagnosis of RA in a specialized center in Colombia. Methods A descriptive, cross sectional study. Were included patients who were referred from primary care centers to a RA specialized center in a 48 month period with presumptive diagnosis of this disease. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record including all previous data; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Frequencies and percentages were calculated for the demographic and clinical characteristics of the cohort of patients in which the diagnosis of RA was ruled-out. Results In 5176 patients was found a wrong diagnosis of RA. Of these misdiagnosed patients, 4.385 (85%) were women, and 791 (15%) men, with an average age of 59 ± 13 years old. Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 2930 patients (56.6%), systemic lupus erythematosus (SLE) in 369 patients (7.1%), Sjögren syndrome in 237 patients (4.6%), spondyloarthropathies in 135 patients (2.6%), gout in 95 patients (1.8%), and in 28.3% of cases other diagnoses including all kinds of soft tissue rheumatism. Conclusions Almost half patients with presumptive RA diagnosis in primary care centers in Colombia are misdiagnosed. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis. Disclosure of Interest None declared

SAT0132 Presence of Psychological, Sexual and Sleep Disorders in Patients with Rheumatoid Arthritis

Background The rheumatoid arthritis (RA), as known, causes inability in various performance areas mostly in the musculoskeletal, but few is known about psychological, sleep and sexual problems. Objectives The aim of this study is to describe the socio-demographic profile of patients with RA in specialized RA clinic in Colombia, where we identified disorders in areas besides the physical or musculoskletal, like psychological, sexual and sleep. Methods A descriptive study was performed in a specialized clinic dedicated to care patients with RA. 1298 RA patients were included in the study, which were seen by the area of psychology; information was collected through semi-structured interviews and non-probability sampling, also using classificatory criteria of pathologies described in CIE 10 diagnostic manual, applying descriptive epidemiology for continuous variables, measure of central tendency and dispersion for qualitative and categorical variables through percentages and averages. Results Total sample of patients was 1298, 1048 (80%) were women and 250 (19%) were men. Patients had a DAS28 2.6 in average ± 1.1; mean age was 55.1 ± 8.8 years; 58% of patients were medium socio-economical level and the 34% were low socio-economical level; 59% were married, 18% were divorced, 14% is single and 6% were widowed. Related with the occupation, 25% were retired because age and 10% had handicap retirement pay; 24% were dedicated to housekeeping and 35% were working. Related to education 6% were illiterate, 44% had elementary school, 33% high school, 8% had a technical degree and only 7% had college level. According to CIE-10 739 patients (57%) had psychological disorders, 279 patients (21%) had sexual and 373 (28%) had sleep disorders. Conclusions According to these findings there is a high prevalence of patients with low-medium socio-economical levels in RA which shows a possible correlation of a socio-demographic unfavorable situation with presence of disease. Also there are high rates of psychological, sexual and sleep comorbidities, which implies that measures must be implemented in order to improve these areas of performance in patients with RA. Disclosure of Interest None declared

AB1081-HPR Pharmacological Adherence To Conventional or Biological Therapy in Patients with Rheumatoid Arthritis in A Colombian Specialized Rheumatology Center

Background The lack of pharmacological adherence and consecutive therapeutic failure is a prevalent and relevant problem in clinical practice, especially in the treatment of chronic diseases such as rheumatoid arthritis (RA). In the context of chronic diseases, World Health Organization considers lack of adherence like a public health priority because represents negative consequences like: therapy failures, higher rates of hospitalization and increased costs of health care. Objectives The aim of this observational study was determine adherence to treatment in patients with RA, their demographic characteristics and clinical variables. Methods An observational, descriptive cross sectional study conducted in a non-probability sample of convenience in patients with RA who consult to rheumatology institution specialized in RA patients. Descriptive epidemiology was applied for continuous variables, measures of central tendency and dispersion for categorical and qualitative variables (averages/percentages); we used Pearsons chi-squared test (χ2) and T student test to evaluate bivariate correlation. Results 356 patients were included, 186 (52%) received DMARDs therapy and 170 (48%) biological therapy. 309 (86%) were female and 47 (43%) were male meanDAS28 was 2.5 ± 1 HAQ was 0.87 ± 1.3. The most frequent comorbidity was osteoporosis 145 (40%) and hypertension 135 (37%). 103 (28%) participants suspended the medication when they felt polimedicated. In the group using DMARDs 71 (38%) suspended the medication due to an adverse event and in the biological therapy group 55 (32%). 71 (38%) patients in the group with DMARDs referred administrative difficulties while in the group with biological therapy 56 (32%) referred the same issue. When we explored the adherence, regarding age the group where we found fewer adherence in the group between 40 and 60 years this correlation was not statistically significative. When patients suspended the medication when they felt medicated with many drugs mean DAS28–2.6 higher than who did not suspend medication mean DAS28–2.4. When the medication due to an adverse event was suspended mean DAS28–2.57 higher than those who did not suspend the medication (DAS28–2.46) and was statistically significative. Conclusions This study shows that most of patients (two thirds) are adherent to conventional or biological treatment; however a important number remains non-adherent with a higher DAS28 score with clinical and economical implications. Disclosure of Interest None declared

SAT0130 Drug Usage Analysis and Comparative Medication Expenses in Patients with Rheumatoid Arthritis Using Conventional or Biological Therapy

Background In the last years it has seen a marked improvement in the treatment of rheumatoid arthritis (RA) by using conventional DMARDs and more recently with the introduction of biologics; biological therapy is useful to prevent clinical and radiological progression in patients with RA but is associated with high costs and has impacted budget in Colombian health system. Objectives The purpose of this study was to assess drug usage of conventional treatment and biologic agents in terms of reduction of the Disease Activity Score 28 (DAS28) and comparative medication expenses associated in patients with moderate-severe RA during a 24 month period. Methods We conducted a real-world, retrospective, cross-sectional study, based on information from a specialized in RA center in Colombia where there is a model with therapeutic goals like T2T and a multidisciplinary approach. Subjects with moderate-severe disease activity received conventional treatment or biologic therapy, and were followed-up and treated according to DAS28; therapy had to be adjusted with DAS28 >3.2 unless the patients conditions did not allow it. Descriptive epidemiology was done and the overall drug costs were assessed and compared between the two types of therapies. Results 526 patients using conventional treatment were included, mean age 63.5 ± 11.8, 424 (80%) female and 102 (20%) male. These patients had a DAS28 on average 4.5 ± 1 at beginning and after 24 months 410 patients (78%) got remission/low disease activity status with a mean DAS28 2.57 ± 1. On the other hand, 303 patients using biologics were included, mean age 58.5 ± 9.4, 251 (82%) female and 52 (18%) male; after 24 months of observation 154 patients (50%) obtained remission/low disease activity status with a mean DAS28 of 2.6 ± 1. Cost of conventional DMARD treatment for RA in Colombia was about 850 US dollars/patient/year because mostly of patients have more than one DMARD; use of biologics cost

AB1038 High Costs for Health System of Misdiagnosing Osteoarthritis as Rheumatoid Arthritis

7,725 US dollars/year/patient, ranging between the cheapest biological and the most expensive (

AB0369 Comparative Effectiveness Abatacept, Adalimumab and Rituximab in Patients with Long-Standing Rheumatoid Arthritis in A Real-Life Setting

4,878 and

SAT0082 Biological Therapy and Improvement of Disease Activity in A Cohort of Rheumatoid Arthritis Patients Treated under Treat To Target Recommendations in A Specialized Center

12,774 US dollars/year respectively); that means conventional treatment is nine times cheaper in comparison with costs of biological therapy and possibly more effective. Conclusions This study showed that it is possible to decrease disease activity and obtain a significant cost-reduction in treatment of RA by using conventional DMARDs in a model with therapeutic goals like T2T and optimizing a multidisciplinary approach; the use of biologic therapies in the treatment of RA continues being evaluated but is associated with high costs; we show real-world data on drug utilization in patients with moderate-severe RA in a low income developing country. These observations could be used by decision makers in order to consider health decisions; nonetheless, further research based on cost-effectiveness analysis and cost-comparison is needed to verify these results. Disclosure of Interest None declared

SAT0231 Conventional Dmard Therapy and Improvement of Disease Activity in a Cohort of Rheumatoid Arthritis Patients Treated Under Treat to Target Recommendations

Background There are an important number of patients with osteoarthritis (OA) that are misdiagnosed as rheumatoid arthritis (RA) in general practice in Colombia. They are treated as such with disease modifying anti-rheumatic drugs (DMARDs), leading to higher economic costs for health system. Objectives The aim of this study was to calculate the possible direct economic costs of the care of OA patients misdiagnosed as RA in a 48 month period in a cohort of patients derived to a specialized RA center in Colombia. Methods A descriptive cross sectional study was performed. Patients derived during a 48 month period to a RA specialized center with presumptive diagnosis of this disease and found finally diagnosed with OA were included in analysis. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Then we described the direct costs of care in Colombian pesos (COP) of these false-positive RA patients assuming an average of 4 visits/year to general practitioner (8.400 COP/medical appointment), 2 visits/year for physiatrist and orthopedics (33.995 COP/ medical appointment) and 4 set/year of conventional laboratories (92.161 COP/set). Cost of medication doses were calculated for an average use of methotrexate, sulfasalazine, chloroquine and prednisolone (200.840 COP/monthly). Indirect costs were not calculated. Results We found 2930 OA patients misdiagnosed as RA in a period of 48 months. For each patient we calculated 33.600 COP/year for general practitioner visits, 135.980 COP/year for specialized medicine visits, 368.644 COP/year for laboratory sets and 2.431.248 COP/year for medications. This leads to a total cost of 2.969.472 COP/year per patient. Given a total of 2930 misdiagnosed patients cost rise to 8.700.552 million COP/year (

FRI0127 Outcomes of disease activity in a 5-year large cohort of rheumatoid arthritis patients treated under treat to target recommendations and a multidisciplinary care model – a real-life experience

2,900,184 US dollars/year). Conclusions There is an important economic implication of the misdiagnosis of OA as RA, being this the most frequent mistake in the diagnosis of this disease. The implementation of educational programs for health care primary physicians and specialized RA centers where a process of screening diagnosis is made could save this amount of money for the health system in Colombia. Disclosure of Interest None declared