Background:Biological drugs have revolutionized the treatment of immune-mediated inflammatory diseases (IMIDs). Current guidelines reserve these drugs for patients with severe refractory disease.Biologic drugs are expensive, but as they reach patent expiry, the introduction of lower-cost biosimilars reduces their impact on health care budgets. It is estimated that NHS England could save £300 million by 2021 following the recent launch of adalimumab biosimilars [1]. As part of this process, there has been a mandatory switch of originator adalimumab to biosimilar adalimumab throughout the U.K.Objectives:To evaluate the impact of the switch to biosimilar adalimumab in individuals with inflammatory arthritis at two NHS trusts in the East of England and calculate the proportion and reasons for switch back to originator adalimumab or a second biosimilar at 12 weeks.Methods:Both hospitals ran dedicated ‘switch’ clinics. All patient records were reviewed retrospectively.Results:855 patients with different IMID switched from originator to biosimilar over 13 months. At 12 weeks, 730 patients (85%) maintained the switch, 71 patients (8.7%) switched back to the originator, and 54 patients (6.3%) switched to other biosimilars of the same drug.Table 1.Primary outcome analysis of switching from originator to adalimumab biosimilarDiagnosisTotal patient switched from originatorAverage duration (year) of use of originator before bio switch (for patients continue using bio switch)Total patients continuing (At 12 weeks)Average duration (year) of use of originator before bio switch (for patients switched back to originator)Total patients switched back to originator or other biosimilarRheumatoid Arthritis3567.9314 (88%)4.942 (12%)Axial Spondyloarthritis2606.4213 (82%)4.547 (18%)Psoriatic Arthritis2185.9187 (86%)2.931 (14%)Juvenile Arthritis163.714 (88%)4.52 (12%)Others52.22 (40%)0.83 (60%)Total8557.0730 (85%)4.2125 (15%)Table 2.Reasons for back to originator or another biosimilarReasons for back to originator or another biosimilarNumber back for IntoleranceNumber back for InefficacyPainful injection69BASDAI/Spinal Pain13Pain/Others19TJC, SJC, VAS4Rash/Allergic reaction5DAS3Headache5PsARC2Nausea4No Detail1Total102Total23%82%18%Conclusion:Switching to a biosimilar was successful in the vast majority of patients and is associated with significant saving. The list prices for originator Adalimumab is £9,155/person/year and £8,238/person/year for biosimilar Adalimumab respectively [2]. By switching we will save approximately £719,402 per annum (9.2% cost reduction).References:[1]NHS England. NHS set to save record £300 million on the NHS’s highest drug spend 2018 [cited 2018 November 30].https://www.england.nhs.uk/2018/11/nhs-set-to-save-record-300-million-on-the-nhss-highest-drug-spend/[2]https://bnf.nice.org.uk/medicinal-forms/adalimumab.htmlDisclosure of Interests:Rifat Mazumder: None declared, Marianne Loke: None declared, Chetan Mukhtyar: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Emese Balogh: None declared, Emerald Sekaran: None declared, Mushfika Sultana: None declared, Mabel Odonkor: None declared, Karen Miles: None declared

Introduction:Obstetric fistula surgery presents many challenges. The injury usually occurs in resource-poor areas and is thus managed in hospitals that are themselves poorly resourced. The pathology is complex and extensive, affecting any and sometimes all parts of the lower urinary tract. The long obstructed labour and resulting ischemia throughout the pelvis can destroy all the normal mechanisms for urinary continence. 1 It is one thing to be able to close the defect and try to restore normal anatomy, but it is quite another thing altogether to obtain a functional closure, ensuring normal continence. There are varied reports about the extent of incontinence after fistula surgery, from 8% 1 to more widely accepted figures of 18-33%, 2 even up to 47% in an unpublished survey performed in the Addis Ababa Fistula Hospital in 2003. As with all things, it depends on how closely a fistula surgeon look for the problem. In the early work by Kelly and Kwast, 1 the figure was the number of women returning to the hospital with continuing incontinence despite a closed fistula. It is likely that many women would have remained at home with mild incontinence. The figures of 18-33% had accepted way of looking for incontinence including a basic set of structured questions ranging from'are you wet with cough or heavy activity? 'are you leaking urine involuntarily when lying?. 2 A cough examination with a full bladder was used to confirm the diagnosis.The exact nature of the incontinence is often complex and only a handful of studies have investigated the nature of the pathology. One study 3 of 22 women with severe incontinence following fistula closure underwent urodynamic assessment: 41% had genuine stress incontinence (GSI); 14% had GSI and poor Residual urinary Incontinence after SuccessfulRepair of Obstetric Fistula

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