Introduction: In patients with rheumatoid arthritis (RA) who have an inadequate response to or intolerance of their first biologic diseasemodifying antirheumatic drug (bDMARD), guidelines recommend switching to a different biologic class. The objective of this study was to compare persistence with subcutaneous (SC) tocilizumab to persistence with other SC bDMARDs when these drugs are used as subsequent-line therapy in RA patients who previously received C 1 bDMARD. Methods: RA patients in a US administrative claims database who initiated a second-or subsequent-line SC bDMARD between January 1, 2012 and June 30, 2017 (initiation date = index date) were included. Persistence was defined as the number of days between the bDMARD initiation date and (1) the last supplied day of medication fill (primary) or (2) the day on which the patient switched or there was a gap in treatment of [ 90 days (secondary). Parametric survival models utilizing an exponential distribution with a robust variance estimator were used to compare persistence with tocilizumab to persistence with other bDMARDs. Results: A total of 10,301 patients with 12,704 bDMARD episodes were included. Patients receiving tocilizumab had a significantly higher adjusted median (95% CI) number of days of primary persistence [333 (311-356)] than those receiving adalimumab [280 (268-293); P \ 0.001], certolizumab [262 (241-284); P \ 0.001], and etanercept [289 (274-304); P = 0.001], and a similar persistence to those receiving abatacept [320 (305-335); P = 0.327] and golimumab [304 (274-333); P = 0.122]. Conclusion: Among patients with RA who had previously received C 1 bDMARD, tocilizumabtreated patients exhibited a similar or significantly better biologic persistence than those receiving other bDMARDs.

Objectives: As demand for TKA in Australia is steadily growing over the past decade, there is increasing interest in optimizing the post-acute care to reduce hospitalization and overall financial burden. Post-operative recovery is influenced by many factors, such as management protocols or patient characteristics. Hence, this study aims to describe the real-world hospital LOS and discharge disposition of TKA patients at an acute hospital. Methods: This retrospective cohort study included 106 out of 121 unilateral primary TKA patients (diagnosis for gonarthrosis, ICD-10-AM) between January 2013 and December 2015. Primary and secondary outcomes were LOS, discharge readiness and destination respectively. Baseline demographic, clinical events and implant type data were captured. Descriptive analyses are reported with means and standard deviations for continuous variables and frequency and percentage for categorical variables. The difference in actual LOS and discharge readiness was examined for factors that may affect this outcome. Results: Provisional results from 106 TKA patients (median age 69.2 years; 65% female; 82% obese, 94.4% ASA II-III) showed a mean LOS of 6.0 days (SD: 2.8, 95% CI 5.5-6.6). 98% of the patients were discharged home with or without home care support. 31.1% of patients had rehabilitation. All patients achieved discharge readiness before actual discharge. Only 18% of patients were discharged on the same day they achieved discharge readiness. Analysis shows significantly longer days for actual discharge for patients having clinical events, such as transfusion or other procedures. Conclusions: Our real-world study showed that while the hospital displayed a mean LOS within the national reported average, patients could achieve discharge readiness 1.5 days earlier. However, patient clinical events could induce delays in actual discharge. Alongside fast-track programs to optimize patient care path and costs, these findings can potentially help healthcare providers to further enhance recovery and potentially reduce LOS according to patient profiles.

BackgroundThe EULAR and ACR clinical guidelines recommend switching to a different disease-modifying antirheumatic drug (DMARD) when biologic-treated patients experience treatment failure or toxicity. Lack of efficacy and adverse events are among the most commonly reported reasons for switching biologic therapies. Limited information is available regarding biologic therapy persistence across subcutaneously administered (SC) biologic agents in the real-world setting, as well as for comparative information on biologic persistence for SC biologics among patients with rheumatoid arthritis (RA) who are not naive to biologic treatment.ObjectivesTo compare persistence of SC biologic DMARDs (bDMARDs) in patients with RA as subsequent-line therapy following a failure of first line bDMARDs.MethodsUS administrative claims data were used to create a longitudinal cohort of adult patients with RA initiating SC biologic between 1/1/2012 and 6/30/2017 (initiation date = index). Patients were required to have failed 1st bDMARD to enter study (but could later switch therapy) and to have 6 and at least 3 months of continuous enrollment pre- and post-index (date of prescription for bDMARD). Those with other autoimmune conditions were excluded from the study. Outcomes were biologic persistence, defined as number of days between initiation date and last supplied day of last fill. Parametric survival models with exponential distribution with robust variance estimator were used to compare outcomes for tocilizumab versus other biologics, adjusting for differences in baseline characteristics, accounting for correlation among different bDMARD episodes.ResultsThere were 10,301 patients with 12,704 bDMARD episodes: abatacept (n=2,988), adalimumab (n=3,599), certolizumab (n=982), etanercept (n=2,760), golimumab (n=745), or tocilizumab (n=1,630). Mean age was 51.0-53.3. Mean [SD] Elixhauser comorbidity scores were significantly higher (p<0.001) for tocilizumab (2.8 [2.3]) compared to abatacept (2.5 [2.2]), adalimumab (2.5 [2.1]), certolizumab (2.4 [2.0]), etanercept (2.4 [2.0]), or golimumab (2.4 [2.2]). Adjusted median days (95% CI) of persistence were: abatacept 320 (305, 335); adalimumab 280 (268, 293); certolizumab 262 (241, 284); etanercept 289 (274, 304); golimumab 304 (274, 333); and tocilizumab 333 (311, 356). Tocilizumab had significantly (p < 0.05) higher persistence compared to adalimumab, certolizumab, and etanercept (Figure 1). Of patients who were observed for 12 months, 45% of patients initiated tocilizumab bi-weekly and 55% initiated weekly. Of the 347 patients initiating bi-weekly tocilizumab, 33% switched to weekly over 12-month follow up; the mean time to switch was 177 days. After 12 months of follow-up, approximately 68% of patients finished on weekly dosing and 32% on biweekly dosing.ConclusionAmong patients with RA who previously used ≥1 other biologic, tocilizumab-treated patients had similar or statistically significantly better biologic persistence compared with other biologics.AcknowledgementThis study was funded by G...