POS0234 HOW CLOSELY DO GERMAN RHEUMATOLOGISTS FOLLOW THE EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF RHEUMATOID ARTHRITIS WHEN MAKING THERAPEUTIC DECISIONS?

Background EULAR developed recommendations for the management of rheumatoid arthritis (RA) suggesting treatment escalation and changes at different stages disease to reach least low activity with latest updates in 2013 (1) , 2016 (2) 2019 (3) . The recommendation consider adding a biologic disease-modifying anti-rheumatic drug (bDMARD) – or, since 2016, Januskinase inhibitor (JAKi) after first conventional synthetic (cs) DMARD had failed if poor prognostic factors (PPF) are present, was strengthened 2019. Since then, it is recommended that bDMARD or tsDMARD should be added Objectives How closely followed daily rheumatologic practice Germany? Methods Data were used from long-term observational cohort RABBIT, which enrols patients RA starting JAKi, csDMARD one previous failure. According publication recommendations, periods [I] 01/2014 12/2016, [II] 01/2017 06/2020 [III] 07/2020 04/2021 investigated. Patients who moderate (DAS28≥3.2) selected analysed, they started csDMARD, JAKi. further stratified by prior treatments presence PPF (≥4 swollen joints, positive factor ACPA, erosions). Results Of 15,150 enrolled 2007, 2,922 initiated period [I], 4,580 415 (see Table 1). proportion 1 ≥1 agreement switched increased 30% (only bDMARDs) 68% (bDMARDs + JAKi) [III]. proportions even higher 2 csDMARDs (86% 93% [III]). As recommended, JAKi more often as line therapy (after csDMARD) 1. Number percentages disease. & no bDMARD/ ≥2 bDMARDs/ Recommendation change/add add JAKi** change another bDMARD/JAKi Total numbers 61 2073 2220 1700 1863 Period n=25 n=848 n=986 n=543 n=520 12/2016* N=2,922 21 (84.0%) 594 (70.0%) 134 (13.6%) 199 (36.6%) 275 (52.9%) 4 (16.0%) 254 (30.0%) 852 (86.4%) 344 (63.4%) 245 (47.1%) n=32 n=1,090 n=1,136 n=1,054 n=1,268 N=4,580 16 (50.0%) 469 (43.0%) 96 (8.5%) 261 (24.8%) 274 (21.6%) 13 (40.6%) 509 (46.7%) 822 (72.4%) 403 (38.2%) 288 (22.7%) 3 (9.4%) 112 (10.3%) 218 (19.2%) 390 (37.0%) 706 (55.7%) n=4 n=135 n=98 n=103 n=75 N=415 0 43 (31.9%) 7 (7.1%) 15 (14.6%) 9 (12.0%) (25.0%) 64 (47.4%) 60 (61.2%) 36 (35.0%) 23 (30.7%) (75.0%) 28 (20.7%) 31 (31.6%) 52 (50.5%) (57.3%) indicated green. * not available. ** [I]: Addition considered; [II]: considered, current would start bDMARD; [III]: added. PPF, factor. Conclusion have become established, especially bionaive patients, but reached significance biologics certain patient groups. early decision has been made frequently recent years, yet third did receive escalation. We cannot conclude data, considerations led escalate. note, German rheumatologists rather follow guidelines (4 ) are, however, very similar recommendations. References [1] PMID: 24161836; [2] 28264816; [3] 31969328; [4] 29968101 Acknowledgements RABBIT supported joint, unconditional grant AbbVie, Amgen, BMS, Fresenius-Kabi, Galapagos, Hexal, Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, VIATRIS UCB. Disclosure Interests Yvette Meissner Speakers bureau: Doreen Huschek: None declared, Angela Zink Sanofi, Jörg Kaufmann: Martin Bohl-Buehler Speaker several companies unrestricted educational programs, each them state-of-the-art-talks., Consultant of: PreviPharma, basic research osteology, overlap rheumatological diseases, Anja Strangfeld Celltrion, Janssen,