Op0181 Which Mode of Action Is Best for Difficult-to-Treat Rheumatoid Arthritis When Switching Biologics or Jak Inhibitors?

Background: Some patients with rheumatoid arthritis (RA) have difficulty in controling disease activity even after using multiple biological agents or Janus kinase inhibitors (BIO/JAKi). These patients are considered as difficult-to-treat RA (D2TRA) and result in poor outcome because of persistent inflammation. Objectives: We investigated the efficacy of switching BIO/JAKi by their mode of action among patients with D2TRA. Methods: Total of 185 patients switched to another BIO/JAKi because of inadequate response to previous BIO/JAKi and being considered as D2TRA in our institution as of September 2022. The following BIO/JAKi consists of TNF inhibitors (TNFi; n=20), IL6 inhibitors (IL6i; n=32), Abatacept (ABT; n=29), JAK inhibitors (JAKi; n=104). We investigated clinical characteristics and efficacy and retention rate of following BIO/JAKi for 52 weeks. Results: The average age was 62.9, disease duration was 16.1 years at the time of switching (baseline). MTX use rate was 85%, 38%, 48%, 46%, and glucorticoid use rate was 45%, 66%, 55%, 34%, and numbers of used BIO/JAKi was 3.4, 2.9, 2.7, 4.0 in TNFi, IL6i, ABT, JAKi, respectively at baseline. Retention rate of the following BIO/JAKi at 52w was 60.0%, 56.3%, 51.7%, and 48.1%, respectively. DAS28ESR improved from 5.66 to 4.37, 5.19 to 2.78, 4.62 to 4.13, 4.72 to 3.98, and CDAI improved from 27.3 to 12.7, 22.1 to 10.5, 19.2 to 13.6, 20.0 to 12.2, and MMP3 improved from 185.3 to 119.0, 365.6 to 137.8, 172.3 to 141.7, 287.5 to 110.6 at 52w, respectively. IL6i and JAKi especially improved MMP3 and CRP, whereas TNFi improved CDAI during 52w. HAQ and glucocorticoid use had not been improved. Conclusion: Switching BIO/JAKi improved disease activity and considered to be effective for patients with D2TRA, regardless of mode of action. REFERENCES: [1] Nagy G, Roodenrijs NMT, Welsing PM, Kedves M, Hamar A, van der Goes MC, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. (2021) 80:31–5. Acknowledgements: NIL. Disclosure of Interests: Takuya Tachibana: None declared, Yutaro Yamada: None declared, Kenji Mamoto: None declared, Tadashi Okano Abbvie, Takahito Kojima: None declared, Shohei Anno: None declared, Kazuki Orita: None declared, Takahiro Iida: None declared, Masahiro Tada: None declared, Kentaro Inui: None declared, Tatsuya Koike Abbvie, Chugai, Hiroaki Nakamura Astellas, Asahi Kasei