(C-107) Investigating Treatment Pathways for Rheumatoid Arthritis in Adult Patients: Insights from Real-World Data

Background: Despite improvements in the diagnosis and management of rheumatoid arthritis (RA), there remains a dearth of knowledge regarding to current standard care and treatment pathways.

Objectives: This study’s aim was to evaluate the treatment pathways after initiating Disease-Modifying Antirheumatic Drugs (DMARDs) among newly diagnosed RA patients.

Methods: A retrospective cohort analysis was conducted to evaluate lines of treatments for newly diagnosed RA patients and compare different sequence of RA treatments. The line of treatment was considered complete when a new treatment appears in the patient record, a patient dies, a patient’s medical record ends, or when the analysis time window ends (3 or 12 months). The TriNetX database was queried for all adults (≥ 18 years) with RA utilizing international classification of Disease-10 (ICD-10) codes, M05 and M06, from 2004-2024. All medications associated within the first 3 and 12 months of the index date (first record of RA diagnosis) were assessed utilizing Medical Prescriptions Normalized codes. These included anti-inflammatory drugs, conventional synthetic DMARDs (csDMARDs), and biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs) monotherapy or in combination.

Results: The initial cohort was 650,240 patients included. Overall, the most prescribed initial treatments were corticosteroids (40%). For 3- and 12-months post first diagnosis, csDMARDs treatments were given to 23% and 30% of patients, and biologic DAMRDs treatments were initiated in 5% and 8%, respectively. The most prescribed initial csDMARDs were methotrexate and hydroxychloroquine, 36% and 30%, respectively. The most prescribed initial bDMARD was adalimumab, 5% (3-months) and 8% (12-months). For first to the 6th line of treatment (LOT), most patients received corticosteroids. In first 3 months of treatment initiation, 33% of patients received DMARDs in first LOT monotherapy or in combination with analgesic/corticosteroids. This proportion increased to 41% in the 6th LOT. Likewise, this proportion increased in the first year of treatment initiation to 44%. Twenty-eight percent of the patients received csDMARDs in first LOT. Instead, only 3% received bDMARDs. However, this proportion increased to 11% in the 6th LOT while csDMARDs decreased to 33%. Adalimumab was the most common bDMARDs in first LOT (3%) to 6th LOT (8%). Tofacitinib was the most prescribed tsDMARDs in first LOT (1%) compared to 2% in the 6th LOT.

Conclusions: The present study provides insights on treatments pathways for adult patients diagnosed with RA. Contrary to the established guidelines, a noticeable delay in starting active treatment like DMARDs therapy often exists between these recommendations and daily clinical practice.