P111 Regional variation in prescribing of biologics and targeted therapies across England: a population-level study

Abstract Background/Aims Biologics and other targeted therapies have transformed care for people with immune-mediated inflammatory diseases, such as rheumatoid arthritis and psoriasis. National data have shown a 60% increase in the prescribing of these therapies across treatment indications in England since 2019. However, these national trends potentially mask underlying variation at a local level. Our aim was to examine regional variation in the prescribing of biologics and targeted therapies for chronic inflammatory disorders in England between 2019 and 2025. Methods We analysed Secondary Care Medicines Data, aggregated across therapeutic indications, from all NHS hospitals in England between April 2019 and March 2025. We compared trends in monthly issued drug quantities for therapies targeting TNF, IL-6, JAK, CD20, CTLA-4, IL-17, IL-12/23, IL-23, IL-1, BAFF, PDE4, integrin, IL-5, IL-4, IL-4/13, IgE and S1P. Monthly issued drug quantities were standardised using World Health Organisation Defined Daily Doses, with modifications to account for differences in licenced doses between treatment indications. Temporal trends in the estimated number of people prescribed a targeted therapy per 1,000 population were compared between Integrated Care Boards (ICBs) in England. Results While the number of people prescribed targeted therapies has increased nationally since 2019, prescribing rates have been diverging between ICBs throughout England. In 2019, the number of people prescribed targeted therapies varied across ICBs from 2.1 to 6.5 per 1,000 people. By 2024, the rates ranged from 3.1 to 12.6 per 1,000 people. ICBs with the most prescribing of targeted therapies in 2024 were Cambridgeshire and Peterborough, North Central London, and North East and North Cumbria. ICBs with the least prescribing in 2024 were Staffordshire and Stoke on Trent, Hertfordshire and West Essex, and Lincolnshire. While some ICBs with low prescribing in 2019 had large increases by 2024 (including Nottingham and Nottinghamshire), others have remained at a low level throughout (e.g. Staffordshire and Stoke-on-Trent). Conclusion There is widening regional variation in the prescribing of biologics and targeted therapies across England. Further investigation is needed to explore the reasons for this divergence, including differences in commissioning policies, biosimilar usage, population health needs, and the availability of specialist services. Unwarranted variation in prescribing rates must be addressed if we are to ensure equitable access to these highly effective treatments, irrespective of geography. Disclosure M.D. Russell: Honoraria; AbbVie, Biogen, Galapagos, Johnson Sandoz UK. J. Matthewman: None. S. Langan: None. R. Sofat: None. J. Galloway: Honoraria; AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi, and UCB. Grants/research support; Sandoz UK.