AB1824-HPR MULTIPLE TNFI TREATMENT CYCLES AND THE FAILURE OF TRIAL-AND-ERROR CARE FOR PATIENTS WITH RHEUMATOID ARTHRITIS

Background Inhibitors of tumor necrosis factor-alpha (TNFi) are central to management rheumatoid arthritis (RA) though continued use beyond initial failure is negatively associated with response subsequent TNFi treatment. Objectives To assess the patterns recurrent relative reasons for switch as observed in community rheumatology care US. Methods Data: PIONEER-Rheumatology, an EMR and open text-extracted database specific given by American Rheumatology Network (ARN). Study population: Adult (18+ years old) patients RA, TNFi-treated 2018 2021. Full histories were assessed each patient index was set initiation date last prior 2022. Reasons discontinuation extracted from chart notes broadly classified (and subclassified) attrition (death, moved/left practice, non-clinical reasons), lost follow up (LTFU, disengaged), or clinical (treatment goal achieved, lack/loss efficacy, condition resulting disease, treatment, burden). Results 13994 19925 episodes (defined distinct & drug) examined. Of 13944 patients, 9399 (67%) received 1 TNFi, 3527 (25%) 2 1068 (8%) ≥3 TNFi; treatment may have included intervening non-TNFi cycles. [TABLE] Table 1. No. (% row, % column) history (rows) # drugs (columns) Years History Total <1 year 4262 (89%, 45%) 477 (10%, 14%) 37 (1%, 3%) 4776 (100%, 34%) 1<2 1476 (65%, 16%) 680 (30%, 19%) 118 (5%, 11%) 2274 2<3 957 (59%, 10%) 530 (33%, 15%) 139 (9%, 13%) 1626 12%) 3<4 634 (53%, 7%) 410 (35%, 144 (12%, 1188 8%) 4<5 606 (55%, 6%) 352 (32%, 135 1093 ≥5 1464 (48%, 1078 31%) 495 (16%, 46%) 3037 22%) (67%, 100%) (25%, (8%, discontinuation/switch available 4254/4595 (93%) 998/1068 treated 2+ 3+ respectively. Lack/loss efficacy reason more discontinuations 2689/4254 (63%) 829/998 (83%) For a subset ≥1 pre-index, 1+ 2690/3765 (71%) 814/936 (87%) who Conclusion A third study >1 most discontinuing due efficacy. Though trial-and-error seemingly standard RA management, this suggests that some do not benefit approach. Reference [1] Helfgott S, Huston K, Singh J, Soloman N, Broestl Cox Milligan Edgerton C. Development Patient-Important Outcomes Data Repository (PIONEER) Rheumatic Diseases; An Enhanced Database Combining Electronic Medical Insight Chart Reviews [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/development-of-the-patient-important-outcomes-data-repository-pioneer-for-rheumatic-diseases-an-enhanced-database-combining-electronic-medical-data-with-insight-from-chart-reviews/ . Accessed January 3, 2023. [2] Kleinert Tony HP, Krause A, et al. Impact disease characteristics on therapeutic success during adalimumab arthritis: data German noninterventional observational study. Rheumatol Int. 2012;32(9):2759-2767. [3] Wijbrandts CA, Tak PP. Prediction Response Targeted Treatment Rheumatoid Arthritis. Mayo Clin Proc. 2017 Jul;92(7):1129-1143. Acknowledgements This supported Scipher Medicine. Disclosure Interests Simon Helfgott: None declared, Christopher Adams: Andrew Frick Grant/research support from: GSK, ViiV, AbbVie, AstraZeneca, Scipher, UCB, Takeda, JNJ, Horizon, Gilead, Merck, Kent Huston: Scott Jasvinder Consultant of: Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc., Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, National Institutes College Rheumatology, Zimmer Biomet Holdings, Intuitive Surgical Inc./Philips Electronics North America, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Enzolytics Seres Tonix Pharmaceuticals Holding Corp, Charlotte’s Web Amarin, Viking, Moderna Simply Speaking, Measures (OMERACT), Nehad Speakers bureau: AbbVie/Abbott, Janssen, Amgen, GlaxoSmithKline (GSK), Exagen, Novartis, Colin Novartis Boehringer Ingelheim.