Background In early RA, EULAR recommends a conventional monotherapy (with MTX) as the 1st DMARD and an addition of a biologic drug in case of inefficacy. Due to high medication costs, these recommendations can be followed in very few countries. Most rheumatology clinics have to manage with the optimal use of inexpensive conventional DMARDs in their T2T approach.
Objectives To compare the use of DMARDs, biologics and the clinical effectiveness of care of early RA in two rheumatology clinics with different traditions to use of biologics and DMARDs.
Methods Patients with a new diagnosis of RA in 2007-11 were identified in databases of two rheum. clinics in two countries, and followed until end of 2012. Similarities between the clinics include the size of background population, T2T-approach in care with remission as the treatment target, multidisciplinary care with patient education of T2T, and an electronic monitoring at all visits. Clinical data were compared between the clinics; interval between diagnosis and initiation of a biologic drug was analyzed using Kaplan-Meier statistics.
Results Included were 499 pts in Clinic1 and 519 in Clinic2 with comparable baseline values and demographics, better outcomes in Clinic2, and different treatment strategies (Table) with earlier use of biologics in Clinic1; Figure; thin line Clinic1, bold line Clinic2, p<0.001.
Conclusions The use of biologics vary between countries due to affordability, availability and acceptability. Our results confirm that good clinical results can be achieved in early RA applying T2T strategy in a real world setting using biologics in a minority of patients and that strategy is more important than the drugs used. Furthermore, these results, in line with those of recent clinical trials concerning an active use of conventional DMARDs suggest that EULAR recommendations of the drug treatment of RA should be re-visited.
Disclosure of Interest None Declared