P120 Characteristics of difficult-to-treat rheumatoid arthritis: results from a systematic literature review

Abstract Background/Aims Estimates predict between 10-20% of RA patients meet difficult-to-treat Rheumatoid Arthritis (D2T-RA) classification, representing a clinically distinct cohort. There is a significant unmet need in the identification and management of these patients. Discerning significant characteristics across cohorts may identify predictors for D2T-RA, which may prompt earlier clinical recognition and patient-tailored, holistic management to improve clinical outcomes. This review aims to describe the clinical characteristics of patients with EULAR-defined D2T-RA to help identify and manage predictors, contributory factors, or consequences of difficult-to-treat disease. Methods A systematic literature search of PubMed, Embase and Web of Science databases for studies pertaining to characteristics of D2T-RA was undertaken from database inception to May 2023. Results were screened against strict inclusion/exclusion criteria. Risk-of-bias (RoB) assessments were performed using the Newcastle-Ottawa Scale (NOS) and a modified version for cross-sectional studies (mNOS). Significant (p 0.05) baseline characteristics between D2T-RA and non-D2T patients were extracted for comparison following thematic analysis. Where there was conflict in the direction of the extracted characteristics; the number and quality of studies were used to resolve evidential disagreements. Results 1687 studies were identified, of which seven fulfilled the inclusion criteria. Included studies were observational, published between 2021 and 2023, with mean D2T and non-D2T sample sizes of 83 and 417 patients, respectively. Five of the seven cohorts were European, with two from Japan. Following RoB and dispute resolution, all seven identified studies were included for analysis. Key themes elucidated are shown in table 1. Of note, significant characteristics included female sex, autoantibody positivity, greater annual bone erosion progression, interstitial lung disease, mental health conditions, and non-adherence. Conclusion Greater awareness of clinical characteristics of D2T-RA patients will assist clinicians by promoting the assessment of traits associated with poor treatment response. This is the first review to systematically describe characteristics of D2T-RA patients across multiple cohorts. Several commonly recorded, modifiable characteristics were associated with D2T-RA. Evidential disagreements and heterogeneous study designs were analytical barriers, and clinical intervention studies are needed to determine if addressing these factors in the routine clinical setting improves clinical outcomes and prevention in D2T-RA. Disclosure S. Chambers: None. A.P. Croft: None. R. Singh: None.