Dose reduction of biologic therapy in inflammatory arthritis: A qualitative study of patients' perceptions and needs

IntroductionAlthough patient-reported outcome measures (PROMs) are increasingly used in clinical practice and research, it is unclear whether these instruments cover the perspective of young people with inflammatory arthritis (IA). The aims of this study were to explore whether PROMs commonly used in IA adequately cover the perspective of young people from different European countries.MethodsA multinational qualitative study was conducted in Austria, Croatia, Italy and the Netherlands. Young people with either rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), Still’s disease, psoriatic arthritis (PsA) or spondyloarthritis (SpA), aged 18–35 years, participated in semistructured focus group interviews. Thematic analysis was used and data saturation was defined as no new emergent concepts in at least three subsequent focus groups.ResultsFifty-three patients (21 with RA/JIA/Still’s, 17 with PsA, 15 with SpA; 72% women) participated in 12 focus groups. Participants expressed a general positive attitude towards PROMs and emphasised their importance in clinical practice. In addition, 48 lower level concepts were extracted and summarised into 6 higher level concepts describing potential issues for improvement. These included: need for lay-term information regarding the purpose of using PROMs; updates of certain outdated items and using digital technology for data acquisition. Some participants admitted their tendency to rate pain, fatigue or disease activity differently from what they actually felt for various reasons.ConclusionsDespite their general positive attitude, young people with IA suggested areas for PROM development to ensure that important concepts are included, making PROMs relevant over the entire course of a chronic disease.

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AB0262 CLINICAL EFFICACY OF SWITCHING FROM ORAL TO SUBCUTANEOUS METHOTREXATE IN MANAGEMENT OF RHEUMATOID ARTHRITIS: EXPERIENCE FROM OUT-PATIENT SETTING OF A DISTRICT GENERAL HOSPITAL IN UK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2212 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1157.2-1158

Author(s):

G. Ansari ◽

A. Nandagudi ◽

A. Bharadwaj

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Inflammatory Arthritis ◽

Biologic Therapy ◽

Severe Disease ◽

District General Hospital ◽

Chi Square ◽

Retrospective Audit ◽

Number Of Patients ◽

Chi Square Test

Background:Methotrexate (MTX) is an anchor drug in the treatment of Rheumatoid arthritis. The literature review has shown that subcutaneous (SC) methotrexate has shown better efficacy, less adverse side effects and better compliance in inflammatory arthritis. Our department modified Inflammatory arthritis pathway in 2018 where all patient with moderate or severe disease are switched from oral to SC Methotrexate injection for improved management.Objectives:The aim of our study is to review whether switching of oral methotrexate (PO MTX) to subcutaneous methotrexate (SC MTX) helps to improve disease activity in patients with rheumatoid arthritis and avoids the need to introduce biologic therapy.Methods:We conducted a retrospective audit of patients with rheumatoid arthritis seen between January 2018 to January 2020 recording their age, gender, diagnosis, date of MTX switch and disease activity score 6 months after switching to SC MTX. Significance of change was calculated with test of proportion/chi square test.Results:Fifty patients were reviewed, thirty eight (76%) were female and twelve (24%) were male with age ranging between 34 - 86 years (median 61.5 years). Switching to MTX injection was done within 2 yrs of diagnosis in 21 (42%) patients, between 2-5 yrs of diagnosis in 11 (22%) patients and more than 5 yrs after diagnosis in 18 (36%) patients. The main reasons of switching were either maximum MTX dose (25mg) or intolerance to oral MTX at any dose.After switching methotrexate, review at 6 months showed 26 patients (52%) in remission (compared to 6 at baseline) and 3 (6%) patients avoided the need to go on biologic therapy. Five patient commenced on biologic therapy between 3 and 6 months.Table 1.Disease activity compared at Baseline and at 6 monthsDisease ActivityBaselineAt 6 monthsRemission <2.6626 (p<0.0001)Mild (26-3.19)1110Mod (3.2 - 5.09)259 (p<0.01)Severe (>5.1)85Conclusion:Switching to SC Methotrexate even in patients with long duration of disease results in significant number of patients achieving remission or lower disease activity (P<0.001). This may obviate the need of biologics therapyDisclosure of Interests:None declared

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