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 ...

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

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. Objectives The aim of this study was to describe general change in Disease Activity Score 28 (DAS28) using A T2T strategy during a 24 month period in a large cohort of RA patients treated with conventional DMARDs. Methods A descriptive cross-sectional study was performed. Patients from a rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed using DAS28: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We calculated percentages and averages from this data and divided patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Global change in DAS28 was determined at beginning, 6, 12, and 24 months an assessed using Chi-square test. Results 705 patients were included in this study, 560 (79.3%) women and 145 (20.5%) men. All patients had established disease (more than 2 years of duration) and average age 60.1 y/o. Regarding the entire cohort, majority of patients were using DMARDs alone or in combination 450 (63.8)% of patients were using methotrexate, 481 (68.22%) leflunomide, 176 (24.9%) sulfasalazine, and prednisolone 126 (17.8%). The difference of medians for each variable showed improvement with statistical significance (p<0.00). Activity Month 0, n (%) 6 Months, n (%) 12 Months, n (%) 24 Months, n (%) REM 292 (41.4) 432 (61.2) 498 (70.5) 523 (74.1) LDA 108 (15.3) 143 (20.3) 90 (12.7) 87 (12.3) MDA 254 (36.0) 113 (16.0) 99 (14.0) 80 (11.3) SDA 51 (7,2) 17 (2.4) 18 (2.5) 15 (2.1) p<0.00. Conclusions This study shows general improvement of DAS28 in RA patients treated with conventional DMARDs applying a T2T strategy; it was found a globally increase in the percentage of patients in remission group and decrease in MDA/SDA groups. Standard T2T follow-up in patients with RA should be done based on: correct use of disease activity scores and visits/treatment decisions based on, and was proved that achieving remission/LDA using only conventional DMARDs is a realistic goal in clinical practice. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4824

Background Rheumatoid arthritis (RA) is a disease that in most cases is associated with disability and loss of earning capacity. There is a lack of information about occupation of rheumatoid arthritis patients in Colombia, being this field important in order to improve clinical and social outcomes for them. Also is not studied correlation with disease activity and disability. Objectives The aim of this study was to describe the occupation of a cohort of RA patients and its possible relationship with disease activity and functionality in a specialized center in Colombia. Methods A descriptive cross sectional study was realized. A revision of medical records of a cohort of RA patients was performed, including occupational therapy records. Each patient was evaluated for DAS28, HAQ and OPHI2 (Occupational Performance History Interview 2). Descriptive epidemiology was done, percentages and averages were calculated; Pearson's statistics was used for by-variated analysis. Results Of the 139 RA patients included, 27 (19.4%) were men and 112 (80.6%) women. Mean age 56.1±9 years, for women 55.9 years and for men 57 years. Average DAS 28 for all patients 3.01, (2.5 for women and 2.63 for men), average HAQ were 0.36 (0.43 for women and 0.39 for men). Most frequent occupations (percentage, DAS 28 and HAQ means) were: low impact work 57 (41%, 2.6, 0.44); domestic work 36 (25.9%, 2.43, 0.37); administrative work 31 (22.3%, 2.13, 1.00). It was not established correlation between occupation and disease activity or functionality. Conclusions Interestingly most active RA patients were kindergarten teachers with an average moderate disease activity, followed by sewing operators. Less active disease scores were found on floriculture workers. In regard of functional status, sewing operators had higher scores followed by housekeepers; but in general for all types of occupations HAQ scores were low. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4775

system settings, reimbursement, HTA bodies and evaluation, evidence requirements, procurement process, value perception, and key trends and opportunities. This data was gathered through a partnership between Pharmerit and Ethicon Inc. A targeted literature review was conducted to collect information regarding these topics. If gaps in the knowledge were identified after this review, interviews with local affiliates were conducted. Results: Through our methodology and analysis, the following results were identified. Brazil is growing and enjoys the largest economy and most attractive medical device market in Latin America growing 13.6% (CAGR) over the next decade. Health expenditure is valued at US$502 per capita. Brazil has 200 Million people in the public sector, and 51 Million of those also have private insurance. New laws promote the development and purchasing of national products. Both the public and private sectors are regulated by the Ministry of Health (MoH) and ANVISA for premarket regulatory approval. Pricing is negotiated through tenders and purchasing negotiation, and differ by region. At this time Medical Devices do not have price regulation, but in 2015 a working group was created by the MoH in order to evaluate and regulate medical devices' prices. HTA has grown rapidly leading to constrictions in adoption of new technologies and market access. New guidelines were prepared specifically for medical devices (HTA by CONITEC) in order to promote a better evaluation for medical devices.