BackgroundClinical response in patients with rheumatoid arthritis (RA) using biologics is well-known. However, there is no direct comparison between biologics in cohorts of patients with RA in real-life settings, which could have implications in treatment decisions and health economics.ObjectivesThe aim of this study was to describe a direct comparison in effectiveness between two classical antiTNF biologics (Adalimumab, Infliximab) and one Etanercept biosimilar in patients with long-standing RA in a cohort of real-life.MethodsA descriptive cross-sectional study was performed. Were included 158 patients with at least 6 visits to rheumatologist in last 24 months in a specialized in RA center. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11-13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients and the aim of the study was to look at what percentage of patients who were MDA/SDA disease activity reached a low disease activity or remission. 158 patients with RA and using Adalimumab, Infliximab and Etanercept biosimilar (Etanar® CP Guojian Pharmaceutical Co Ltd, China) were involved. The Etanercept biosimilar was approved for using in Colombia since 2007. Descriptive epidemiology was done, the medians were analyzed using t-Student assuming normality for DAS28 distribution and disease activity was analyzed using Pearson's statistics.Results158 patients were included in this study, 125 (79.1%) women and 33 (20.9%) men. Average age was 59±10 y/o with disease duration of 11 years (0.5-47). 158 patients with diagnosis of RA using Adalimumab, Etanercept and Infliximab were involved: Adalimumab 61 (38.6%), Etanercept 25 mg 62 (39.2%), and Infliximab 35 (22.2%). At 24 months was observed an increase in percentage of patients in remission and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. for Adalimumab at beginning DAS28-3.6 and 24 months later 2.6; for Etanercept biosimilar at beginning DAS28-3.6 and 24 months later 2.6 and for Infliximab at beginnng DAS28-3.6 and 24 months later 2.6. There were not statistically significant differences between analyzed biologics. On the other hand, there were fewer adverse events with Etanercept-biosimilar than Adalimumab and Infliximab; it was statistically significant.ConclusionsThis study shows that the Etanercept biosimilar is as effective as 2 other traditional anti-TNF biological for disease activity control in patients with rheumatoid arthritis in a real-life setting with fewer adverse events, which could have implications in treatment decisions and health economics. On the other hand the study proves effectiveness of implementation of a T2T strategy in patients with ...

ObjectiveThis study aimed to compare the clinical response at 36 months and evaluate the adverse events in a cohort of patients with rheumatoid arthritis treated with etanercept, infliximab, or adalimumab.MethodsAn observational retrospective cohort study was performed. Patients older than 18 years with active rheumatoid arthritis, for which the physician had initiated a treatment scheme with etanercept, infliximab, or adalimumab, were included in the study. The follow-up was conducted through at least trimestral evaluations during the course of 36 months. Outcomes evaluated included Disease Activity Score 28, level of disease activity, Health Assessment Questionnaire, and degree of disability.ResultsThree hundred seven subjects were included in the cohort (108 adalimumab, 107 infliximab, and 92 etanercept). The median Disease Activity Score 28 at the onset was 4.1 and 2.39 at month 36. There were no differences among the 3 medications (P = 0.51). The remission rate was of 7.4 per 100 people per month (95% confidence interval [CI], 6.6–8.3) without differences between groups. The initial Health Assessment Questionnaire median was 1.75 and 0.25 at 36 months. No differences per medicine were found (P = 0.54). The most common adverse effect was dermatitis. Eighteen cases of serious adverse effects occurred, including 11 cases of serious infectious events. The adverse events rates were as follows: infliximab, 24 per 100 people per year (95% CI, 19–29); adalimumab, 22 per 100 people per year (95% CI, 18–27); and etanercept, 12 per 100 people per year (95% CI, 8–16).ConclusionsEtanercept, infliximab, and adalimumab are 3 effective therapeutic anti–tumor necrosis factor alternatives to reduce the level of severity and the degree of disability generated by rheumatoid arthritis. Etanercept presented a rate of adverse events lower than those for infliximab and adalimumab.

BackgroundThere is a lack of expertise in rheumatoid arthritis (RA) diagnosis in primary level of Colombian medical centers, leading to misdiagnosis; many times osteoarthritis (OA) and another rheumatic diseases are misdiagnosed as RA which derives in wrong treatment for patients with clinical and health economics implications.ObjectivesThe objective of this study was to describe demographic and clinical characteristics of a cohort of patients derived to a specialized RA center with presumptive RA diagnosis and finally diagnosed as osteoarthritis.MethodsA descriptive, cross sectional study. Were included patients who were referred from primary care centers to a RA specialized center in a 36 month period with presumptive diagnosis of this disease. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Frequencies and percentages were calculated for the demographic and clinical characteristics of the cohort of patients in which the diagnosis of RA was ruled-out.ResultsOf the 4780 patients evaluated, in 2905 patients (60.7%) diagnosis of RA was confirmed, the remaining 1875 patients (39.3%) had a wrong diagnosis of RA. Of these misdiagnosed patients, 1377 (73.5%) were women, and 498 (26.5%) men, with an average age of 57.6 (±12 years). Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 1108 patients (50.1%), systemic lupus erythematosus (SLE) in 84 patients (4.5%), Sjögren syndrome in 62 patients (3.3%), spondyloarthropathies in 21 patients (1.1%), gout in 31 patients (1.7%), and (39,3%) other diagnoses in of the remaining population.ConclusionsAlmost half patients with presumptive RA diagnosis in primary care centers in Colombia are misdiagnosed as shown in this large cohort. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis.Disclosure of InterestNone declared

BackgroundFrequently, patients with osteoarthritis (OA) are misdiagnosed as rheumatoid arthritis (RA) in primary care centers, leading to wrong treatment and consequent clinical and health economics impact.ObjectivesThe objective of this study was to describe demographic and clinical characteristics of a cohort of patients derived to a specialized RA center with presumptive RA diagnosis and finally diagnosed as osteoarthritis.MethodsA descriptive cross sectional study. Patients were referred and assisted to a specialized RA center in a 36 month period with presumptive diagnosis of rheumatoid arthritis. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Frequencies and percentages were calculated for the demographic and clinical characteristics of the cohort of patients in which the diagnosis of RA was ruled-out.ResultsFrom a total of 4780 Patients derived to specialized in RA center with presumptive RA diagnosis, after medical and laboratory evaluation 1875 (39.3%) had a wrong RA diagnosis; of them 1108 patients (59.1%) had finally osteoarthritis diagnosis. Of these patients 783 (70.6%) were women and 325 (29.3%) men, with an average age of 57.4 (±12 years). Majority of these patients were followed by general physicians or internists and treated with non-biologic and biologic disease modifying anti-rheumatic drugs (DMARDs) in the past years, for an average time of 4.5 years.ConclusionsIn this cohort of patients the most frequent diagnosis of patients misdiagnosed with RA was osteoarthritis, being more than two thirds of them, predominantly women. This shows the need for the implementation of specialized clinics in RA and educational strategies for primary care physicians in order to avoid the impact of this wrong diagnosis.Disclosure of InterestNone declared

BackgroundTreat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA). This strategy is being used last years in Colombia. On the other hand a multidisciplinary care team (MCT) model was generated in order to improve outcomes.ObjectivesThe aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 24-month period in patients with conventional DMARD therapy in a large cohort of patients from a Colombian specialized in RA center with a MCT model.MethodsA descriptive retrospective study was performed. Records of patients using conventional DMARD treatment from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was according to DAS28 as follows: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it. A MCT model means that a patient should be seen by other specialties such as physiatrist, physical and occupational therapy, nutritionist and psychologist at least 3 times a year. We divided patients in three groups: low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission (REM). Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson's statistics.Results767 patients were included in this study, 615 (80%) women and 152 (20%) men. Average age was 63 ± 11 years. Concerning to treatment of entire cohort, 76 (6.8%) patients were using Leflunomide alone, 47 (6%) and Metothrexate alone, 164 (21%) Leflunomide plus Metothrexate, 43 (6%), Leflunomide plus other DMARDs, 84 (11%), Metothrexate plus others DMARDs 168 (22%) and 261 (34%) “only” DMARDs without Leflunomide or Metothrexate. At 24 months was observed an increase in percentage of patients in remission/LDA (up to 85%) and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. At beginning DAS28 was 4.07 ± 1.03 and after 24 months of follow-up DAS28 was 2.7 ± 0.72, showed improvement (p<0.00).ConclusionsThere is a global improvement of DAS28 in a cohort of RA patients receiving only conventional therapy, treated and followed under T2T strategy recommendations and a MCT model. We show real-world data on conventional DMARD utilization in patients with RA in a low income developing country, these observations could be used by decision makers in order to consider health decisions.Disclosure of InterestNone declared