Background/Aims  Telemedicine has not previously been a regular part of routine rheumatology services.Our department adopted telephone clinics during the COVID-19 pandemic. We assessed patient satisfaction by conducting a feedback survey. Our aim was to obtain a patient perspective on remote consultations and on preferred future follow up options including video or face-to-face consultations. Methods  The cohort included 160 rheumatology patients who had a telephone consultation between May and mid-June 2020. All patients consented to receive a further phone call by a different member of the team. Patients had to answer a questionnaire about recent consultation and to rate this on a scale of 1-5. Other questions included whether all their queries were answered; clear action plan made; perceived benefits or disadvantages of telephone consultation; and views about future follow up and any additional comments. Results  71.9% of 160 patients were females while 28.1 % males. Mean age 58.6 yrs. More than half of the patients (60.6%) had a diagnosis of inflammatory arthritis, followed by connective tissue disease (19.3%), other diagnosis (8.1% ) & vasculitis (5.6%). 94.4 % of the patients in this study were return appointments-the remainder new. Feedback results revealed 92.5% patients were satisfied with their consultation with mean score of 4.3/5 (5=best,1= worst). More than 80% agreed that all their queries were answered and a clear action plan was formed during consultation. However ,71.2% would want a face to face consultation if given choice while 54 % happy to have further follow up over the phone. 65% of patients preferred not to have video consultation. Subgroup analysis showed that majority of patients who would accept video consultation were aged between 30-39. Most common benefits described were noted to be convenience; reduced time of work; travel time and safety during pandemic, whilst difficulty in describing symptoms; hearing problems; and severity of disease were disadvantages raised, but numbers were small in our cohort. Conclusion  Telephone clinics were the mainstay during the COVID-19 pandemic.The large majority of the rheumatology patients in our cohort were highly satisfied with this form of consultation. However, interestingly the majority (71% ) would still prefer face-to-face consultation as follow up in the future. Regular follow up in carefully selected patient groups can successfully be performed by telephone clinics with good patient satisfaction. This would help increase capacity within the clinic setting. Disclosure  M. Abdullah: None. N. Heng: None. S. Noor: None. U. Ahmed: None. C. Lavery: None. S. Bawa: None.

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Background:Rituximab (RTX), chimeric anti-CD20 monoclonal antibody, is recommended as a treatment option for rheumatoid arthritis (RA) patients who had inadequate response or are intolerant to other DMARDs including at least one anti-TNF inhibitor1. The most cost-effective dosing and retreatment schedule remains to be defined. Based on series of case reports and observational studies, it is suggested that retreatment with RTX 1g single infusion provides similar clinical outcomes compared with 2 x 1g infusions2. We report our experience of using single infusion in treatment of established RA.Objectives:Our unit adopted the single 1g infusion protocol in 2017. Patients were switched to RTX biosimilar – in September 2017. The aim of this study was to assess the effectiveness of single 1g infusion in maintaining the response in RA patients.Methods:80 established RA patients on RTX were identified using clinical records held on our database. 67.50% (54/80) were on single 1g infusion and 28.75% (23/80) were receiving 2 x 1g infusions. Flare and inadequate response were assessed by comparing DAS scores pre and post RTX treatment and clinical judgement. We also assessed the effectiveness of biosimilar RTX, and in switching to biosimilar RTX.Results:RTX group:Overall retention rate was 57.41% (31/54) in single infusion retreatment group. 31.48% (17/54) flared and 76.47% (13/17) were switched back to 2 x 1g infusions with recapture of response in all patients. 1 patient continued single infusion due to recurrent cytopenia and 3 have not had retreatment yet. 11.11% (6/54) had secondary loss of effect (LOE). No flares were noted in 2 x 1g infusion group. 3.75% (3/80) had severe anaphylactic reaction needing to stop their treatment whereas 5% (4/80) experienced minor infusion reactions but managed to continue their treatment.Switch group:52 patients switched from RTX to biosimilar. 42 received single 1g infusion and 10 had 2x1g infusions. In single infusion group, 53.38% (22/42) maintained response, 33.33% (14/42) flared with recapture of response in 92.86% (13/14) on 2x1g infusions and secondary LOE in 11.90% (5/42). In 2x1g infusion group, 90% (9/10) maintained response whereas 10% (1/10) had secondary LOE.Biosimilar RTX group: There were 25 patients on biosimilar RTX.13/25 (52%) went onto single 1g infusion retreatment protocol. Of these, 3 (23.07%) had flare and 1 (7.69%) had secondary LOE. There were 6 (24%) primary response failures, 2 (8%) minor infusion reactions and 1 (4%) major infusion reaction in this group.Conclusion:One third of patients in our cohort failed to respond to single infusion protocol. These results were reproducible in all groups – RTX, switch and biosimilar RTX single infusion group. Our study suggests clinicians and patients need to be vary in using single infusion protocol as there is significant risk of losing disease control.References:[1]Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor. Available at:https://www.nice.org.uk/guidance/ta195/chapter/1-Guidance[2]Dougados M, Combe B, Le Loët X, et al. THU0087 One single infusion of rituximab 1g might be sufficient in the long-term management of rheumatoid arthritis patients responding to a first cycle of rituximab (2 × 1g): Results of a 2-year multi-center randomized controlled trial. Annuals of the Rheumatic Diseases 2013; 71:182Acknowledgments:Rheumatology Department, Gartnavel General Hospital, Glasgow, UKDisclosure of Interests:None declared

Background:Rheumatology has entered the era of biosimilar drugs. Compared with the original approved biological drug, a biosimilar has highly similar physiochemical characteristics and biological activity1. There is also equivalent efficacy and no clinically meaningful differences in safety and immunogenicity1. Substantial cost savings can be made by starting both biological-naive patients and switching patients receiving original biological DMARDs (bDMARDs) to biosimilar DMARDs (bsDMARDs)2. We present our experience of switching to biosimilars at Gartnavel General Hospital, Glasgow, UK.Objectives:To assess the adherence to bsDMARDs in patients switched from original bDMARDs and to identify factors affecting adherenceMethods:We identified 69 patients on etanercept and 101 patients on adalimumab who were switched to bsDMARDs. We used patient clinical records and DA28 scores held in our database to assess the response to treatment and identify patients who were switched back to original bDMARD. We also identified the reason for switching back to bDMARDs and any safety concerns were also analysed.Results:Retention rate was 79.71% (55/69) in biosimilar etanercept and 90.10% (91/101) in biosimilar adalimumab group respectively. The overall failure rate was 20.29% (14/69) in biosimilar etanercept and 9.90% (10/101) in biosimilar adalimumab group. 15.94% (11/69) in biosimilar etanercept and 7.92% (8/101) in biosimilar adalimumab group were switched back to original bDMARD due to perceived disease flare. Control was regained in all these patients. Only 2 patients in each group (biosimilar etanercept – 2.9%, biosimilar adalimumab 1.98%) had clinically active disease requiring switch to bDMARD with different mechanism of action. 1 patient in biosimilar etanercept group had to stop biologic treatment due to cancer diagnosis.Table.Reasons of switching back to bDMARDReasonbiosimilar etanercept (11/69) 15.94%biosimilar adalimumab (8/101) 7.92%Difficulty using device21Anxiety12Felt worse on bsDMARD01Injection site pain and redness11Hair loss01Cough01Perceived disease flare50Recurrent infections20Not documented01Conclusion:Our study showed overall adherence was good (around 80%) in both switch groups with biosimilar adalimumab doing better than biosimilar etanercept patients. All patients who switched back to bDMARD regained control. Nocebo responses3, such as subjective increase of disease activity and pain-related adverse events were identified as the main factors having a negative impact on adherence to bsDMARDs. No new safety signals were identified.References:[1]Smolen JS, Goncalves J, Quinn M, et al. Era of biosimilars in rheumatology: reshaping the healthcare environment RMD Open 2019;5: e000900. doi: 10.1136/rmdopen-2019-000900[2]National Institute for Health and Care Excellence Biosimilar medicines. 26 February 2016. Available at:https://www.nice.org.uk/advice/ktt15[3]Planès S, Villier C, Mallaret M (2016) ‘The nocebo effect of drugs’,Pharmacology Research & Perspectives,4(2), e00208.Acknowledgments:Rheumatology department, Gartnavel General Hospital, Glasgow, UKDisclosure of Interests:None declared