Ab0779 Factors Determining the Switch of the First Biological Treatment in Rheumatoid Arthritis: Data From the Moroccan RBSMR Registry

Background: Rheumatoid arthritis is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. Biologic disease-modifying antirheumatic drugs (bDMARDs) have modified the course of the disease in recent years by targeting pathogenic cytokines, thereby reducing inflammation and joint pain, and limiting structural progression. However, they are not all effective in all patients, and switching to a second biological treatment is an established approach in cases of failure or intolerance to the initial treatment. Objectives: The aim of this study was to identify the factors associated with switching the first biologic treatment in rheumatoid arthritis. Methods: Our study is a cohort derived from the RBSMR registry (Moroccan registry of biological therapies in rheumatic diseases), a historical-prospective multicenter registry of patients with rheumatoid arthritis retained according to ACR EULAR criteria, aged > 18 years, and treated with biological therapy in 10 rheumatology departments in Morocco, after providing written informed consent. Patients were assessed every 6 months with a scheduled follow-up of 3 years. Inclusion began in June 2017 and ended in January 2019, which marked the first freeze of the database. We conducted both bivariate and multivariate analyses to determine factors associated with treatment switching. Results: A total of 223 patients were included in the rheumatoid arthritis biotherapy registry. The mean age was 51.85 years ± 11.28, the sex ratio was 0.14 M/F, indicating 87.4% women and 12.6% men and the mean duration of progression was 14.07 years ± 8.97. Rituximab was the most commonly prescribed first-line biologic, with a percentage of 74%. Patients switching their first biologic treatment represented 20.17%. The mean age of these patients was 54.56 years. The sex ratio was 14 F/H. Rheumatoid factor (RF) was positive in 95.6% of cases, and anti-cyclic citrullinated peptide antibodies (ACPA) were positive in 89.7%. Erosions were observed in 64% of patients. Rheumatoid arthritis had a functional impact (HAQ > 0.5) in the majority of switchers, with a percentage of 87.5%. In bivariate analysis, patients currently on corticosteroid therapy or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) were more likely to switch their first biological treatment, with p-values of 0.035 and 0.014, respectively. The absence of certain comorbidities, notably diabetes, hypertension, and hypercholesterolemia, was also significantly associated with the switch of the first biological treatment, with p-values of 0.018, 0.032, and 0.004, respectively. Conclusion: The prognosis of patients with chronic inflammatory rheumatism has been revolutionized by the introduction of new biological treatment. Switching the first biologic is a fairly common occurrence in daily practice, despite the great progress made with the advent of these biological treatments. Our study has identified predictive factors of switching the first biological treatment, notably the use of corticosteroid therapy and CsDMARDs, as well as the absence of certain comorbidities. Additional studies are necessary to confirm these results. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.