THU0180 Time to Biologic Therapy Driven by Rheumatoid Arthritis Disease Activity and Severity

Background In patients with early rheumatoid arthritis (RA), aggressive treatment of disease activity with non-biologic disease modifying anti-rheumatic drugs (nbDMARDs) and biologics is recommended in order to reduce the long-term consequence of inflammation (1). We sought to estimate time from use of first nbDMARD to first biologic initiation in RA patients, as well as investigate factors associated with biologic initiation. Methods We identified early RA patients (disease duration 10) at nbDMARD initiation. The median time between first nbDMARD and first biologic was 4.24 years.In univariate analyses, factors associated with time to biologic initiation include patient age (HR 0.98, 95% CI 0.97-0.99), private insurance (HR 1.50, 95% CI 1.18-1.90), moderate/high disease activity with low disease activity the reference (HR 2.01, 95% CI 1.27-3.17), greater disability (mHAQ; HR 1.47, 95% CI 1.08-2.00) and year of enrollment/diagnosis (HR 1.23, 95% CI 1.12-1.3). In multivariable models, only moderate/high disease activity (HR 1.02, 95% CI 1.01-1.04) and patient age (HR 0.98, 95% CI 0.98-0.99) were associated with time to biologic. Conclusions In this real world cohort of RA patients, biologic therapy was started on average 4 ¼ years after initiation of a nbDMARD. Higher disease activity and younger patient age were associated with a reduced time to biologic initiation. References Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic