Pos0669 Frequency and Reasons for Non-Acceptance of Treatment Change in Rheumatoid Arthritis Patients Who Were Recommended a Treatment Change With a “Treat to Target” (T2t) Treatment Strategy

Background: In the treatment of rheumatoid arthritis (RA), targeted therapy "treat to target" (T2T) is recommended as a treatment strategy in EULAR and ACR treatment guidelines (1). Although the newly developed bDMARD/tsDMARD drugs offer new options in the treatment of RA and more effective drugs are used in treatment with the increasing number of rheumatologists, the rates of achieving the treatment goals are lower than desired. In addition to drug efficacy and physician recommendation, patient acceptance and adoption of the treatment are important factors in treatment success (2,3). Objectives: This study aims to investigate the frequency and reasons for treatment refusal in patients who were recommended bDMARD/ tsDMARD treatment with the T2T strategy due to moderate to high disease activity. Methods: The study included 304 RA patients who were followed up in the rheumatology outpatient clinic between 2015 and 2023 and who were recommended bDMARD/tsDMARD treatment due to moderate-high disease activity. A total of 680 recommendations made to 304 patients were retrospectively analyzed and the rejection rates and reasons for rejection were analyzed. Results: Patients who were recommended to switch from csDMARD treatment to bDMARD/tsDMARD treatment received 1-4 treatment recommendations (mean: 1.2) and treatment acceptance rate was 77%. Acceptance at first recommendation was 67.7%. While the rate of one time refusal was 23.4%, two time refusals was 6.6%, 3 or more time refusals was 2.3%. Patients who initially refused the treatment, accepted after in an average of 2.52 months (1-91 months). 23% of the patients did not accept treatment at any suggestion. Reasons for refusal of treatment in csDMARD-bDMARD switching were 24.1% fear, 6.1% false beliefs, 29.3% patient feeling well, 5.1% disapproval of the patient's relatives, 4.2% not being able to come to follow-ups, 16.3% not wanting to. In 13.1% patients, T2T was not recommended by the physician due to comorbidities or lack of follow-up. In 48.4% of patients, switching from bDMARD to another bDMARD/ tsDMARD treatment was performed. Of the one time to ten treatment recommendations (mean: 2.09) made to patients in bDMARD-bDMARD switching, 44.2% accepted the switch at the first recommendation, 20.9% at the second recommendation, and 20.5% at 3 or more recommendations. 14.4% patients did not accept the treatment change. The rate of refusal of at least one treatment change was 35.8%. The reasons for refusal in bDMARD-bDMARD switching were as follows: fear: 15.3%; false belief: 3.8%; not being able to attend follow-ups: 23.1%; patient feeling well: 26.9%; relatives' disapproval: 2%; not wanting to switch without specifying the reason: 23.1%. T2T was not recommended by the physician in 5.8% patients due to comorbidities or lack of follow-up. Reasons for refusing csDMARD-bDMARD and bDMARD-bDMARD treatment transitions demonstrated in Table 1. Conclusion: When implementing a T2T treatment strategy, changing the negative perceptions of the patient and their relatives about the treatment, choosing the most sustainable treatment, considering access to medicines and physicians, and taking into account the patient's self-assessed disease activity should be part of the treatment plan. REFERENCES: 1 Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3-15. 2 Messelink MA, den Broeder AA, Marinelli FE, et al. What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis. RMD Open. 2023;9(2):e003196. 3 Taylor PC, Fautrel B, Piette Y, et al. Treat-to-target in rheumatoid arthritis: a real-world study of the application and impact of treat-to-target within the wider context of patient management, patient centricity and advanced therapy use in Europe. RMD Open. 2022;8(2):e002658. Table 1. Reasons for refusing csDMARD-bDMARD and bDMARD-bDMARD treatment transitions (csDMARD: conventional synthetic disease-modifying antirheumatic drug, bDMARD: biological disease-modifying antirheumatic drug) Acknowledgements: This project is within the scope of TÜBİTAK 2209-A program, is supported with project number 1919B012202471. Disclosure of Interests: None declared.