P116 First-line tumour necrosis factor inhibitor induction in early rheumatoid arthritis is associated with a reduction in future difficult-to-treat disease

Background/Aims Difficult-to-treat rheumatoid arthritis (D2TRA) is characterised by persistent active disease after failure of at least two b/tsDMARDs. D2TRA patients have more disability and disproportionately higher healthcare costs, and their management remains a major unmet need. Despite advances in treatments, a substantial proportion of RA patients become D2T. Whether a bDMARD induction strategy reduces D2T disease remains unknown. Methods Newly diagnosed, DMARD-naïve RA patients who received TNFi induction therapy for 12 months within clinical trials and those who received csDMARD were included as comparators. Data were collected at 5 years, 10 years, and final follow-up in Leeds, UK. The primary outcome was the prevalence of D2TRA. Other outcomes included sustained remission (DAS28 or clinical-documented remission for ≥6 months), delay in bDMARD escalation, healthcare utilisation and treatment status. Results A total of 342 patients were included: 114 in the TNFi induction group and 228 who received usual care with csDMARDs (median age 51, 74.3% female). Of these, 88% had 10-year data. Baseline characteristics were similar between groups. At 5 years, the TNFi induction group had significantly fewer D2TRA (0.9% vs 7.0%, p = 0.037) and a higher rate of sustained remission at 10 years (61.7% vs 45.2%, p = 0.014) and at final follow-up (48.2% vs 67.5%, p < 0.001) (Table 1). The rates of D2TRA were numerically lower in the TNFi induction group at 10 years and the final follow-up but did not reach significance. Those who received TNFi induction were more likely to be in DMARD-free remission and have a delay in requiring escalation to a bDMARD. Healthcare utilisation was significantly lower in the TNFi induction group compared to the csDMARD group and D2TRA patients incurred the highest healthcare utilisation. Conclusion First-line TNFi induction in early RA was associated with less D2T disease at 5 years compared with usual care. It was also associated with increased sustained clinical remission, and lower overall healthcare utilisation. The findings support durable benefits of a bDMARD induction strategy in preventing the development of D2T disease. Disclosure T. Toyoda: None. M. Sheridan: None. K. Abacar: None. F. Shuweihdi: None. J. Nam: None. A. Tan: Honoraria; UCB. L. Bissell: None. P. Emery: Consultancies; AbbVie, Activa, Anatptysbio, AstraZeneca, BMS, Boehringer Ingelheim, Galapagos, Gedeon Richter, Gilead, Immunovant, Janssen, Lilly, Novartis. K. Mankia: Consultancies; AbbVie, ALLin Bio, AstraZeneca, Deepcure, Galapagos, Lilly, Serac Healthcare, UCB, Zura Bio. Honoraria; AbbVie, ALLin Bio, AstraZeneca, Deepcure, Lilly, Serac Healthcare, UCB, Zura Bio. Grants/research support; AstraZeneca, Bristol-Myers Squibb, Deepcure, Galapagos, Gilead, Lilly, Serac Healthcare.