Background Abatacept is a biologic option for patient with Rheumatoid arthritis who have not responded to conventional disease modifying drugs as well as to TNF alpha inhibitors. It has been approved by the National Institute of Health and Clinical Excellence in UK. Objectives We share our experience with Abatacept in patients with Rheumatoid arthritis (RA) in routine clinical practice focussing on clinical response, disease remission and drug survival. Methods A retrospective analysis of RA patients on Abatacept from November 2012 to November 2014 was performed. Data collected included baseline demographics, number of previous synthetic and biologic DMARDs (Disease modifying drugs), baseline DAS 28 (Disease activity score) and change in DAS28 at 6 months. Results Total patients: 138 (100 females and 38 males, F: M ratio 2.63:1). Mean age of population was 63 years. Mean disease duration prior to abatacept was 12.8 years. Mean number of conventional DMARDs used before abatacept were 3.1 and biological DMARDs were 1.8. Abatacept was the first biological therapy used in 10 (7.2%) patients. At last follow up 59 (42.8%) and 57 (41.3%) patients were on intravenous and subcutaneous abatacept. Mean DAS score before starting abatacept 5.89. Clinical response with a change in DAS 28 >1.2 was seen in 76% patients on Abatacept at 6 months. 15.9% Abatacept patients achieved remission at 6 months. 22 (15.9%) patients discontinued abatacept. Drug survival over 6 months was seen in 102 (73.9%) patients. Conclusions Abatacept showed response rate of 76% similar to reported in literature. Drug survival beyond 24 weeks was higher compared to other studies. Abatacept is safe, well tolerated and clinically effective in RA patients in real life. Disclosure of Interest None declared

Background Abatacept is a biologic therapy which suppresses T-cell activation via co-stimulation blockade in rheumatoid arthritis (RA) patients. It became part of our biologic algorithm shortly after initial limited NICE approval in August 2010. In April 2013, NICE widened its recommendation of abatacept in RA patients who have failed to respond adequately to 2 disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate [2]. Objectives In this study we share our experience of abatacept in patients with rheumatoid arthritis (RA) in routine clinical practice from a subregional centre in UK covering a population of 500,000. Methods This was a retrospective analysis of 84 patients who received abatacept therapy from November 2010 to January 2014. Data collected included baseline demographics, number of previous synthetic and biologic DMARDs, change in DAS28 at 3 and 6 months. Response was defined as DAS28 reduction of greater than 1.2. Results 84 patients with RA were commenced on abatacept therapy over 39 months since Nov 2010. The mean age of the patients was 62 years and 74% of them were female. The average number of prior synthetic DMARDs was 2.8 and biologic DMARDs 2.1. Only 2 patients were biologic- naïve before abatacept. 75 patients had received anti-TNF therapy (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), 40 had received rituximab and 7 tocilizumab. The baseline DAS28 was 5.8 and mean DAS reduction at 3 and 6 months was 1.6 (n=41) and 2.0 (n=37) respectively. 25 out of 41 (61%) patients responded at 3 months and this increased to 76% at 6 months (28/37). 14% (5/37) achieved remission at 6 months. 11 patients stopped abatacept therapy, 5 were intolerant of which 3 had infusion reactions, 1 patient had lack of efficacy and 2 loss of efficacy (between 3 and 6 months), 1 patient refused further infusions and 2 patients moved out of area. In a subgroup, the mean DAS reduction at 6 months in seropositive (Rheumatoid Factor or Anti-CCP antibody positive n=14) and seronegative patients (n=16) were 2.54 and 1.88 respectively. Conclusions Our experience shows that abatacept is safe, well tolerated and effective in RA patients with inadequate response to previous synthetic and biologic DMARDs in routine clinical practice. The improvement in DAS28 at 3 months was sustained at 6 months. The numbers are small to draw any conclusion about better response in seropositive RA patients. References NICE recommends wider use of abatacept for treating rheumatoid arthritis (Guidance TA195) August 2010 NICE technology appraisal guidance: Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (Guidance TA280 rapid review of TA234) April 2013 Acknowledgements We would like to thank all members of the Rheumatology team at Cannock Hospital and the patients who participated. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3037

Background: Children and young adults with JIA have increased levels of poor oral hygiene and dental decay [1].Periodontitis and types of arthritis are linked by similar components of blood cytokine profiles.Good dental health can be directly affected in JIA patients due to physical limitations in upper limb movements making brushing and flossing teeth difficult.An important factor in oral care is good dental hygiene and access to dental health practitioners.NHS advice is that all children should be reviewed by a dentist annually and be offered both sealant of their teeth and fluoride varnish at the appropriate time.Our aim was to establish if our patients had any barriers to accessing dental care.Methods: All patients (age 18 and under) diagnosed with JIA in the paediatric rheumatology clinic over a period of 3 months were asked to complete a dental care questionnaire.Parents completed the questionnaire for their children if necessary.Data were analysed using Excel.Results: 30 questionnaires were completed.Demographics were M:F 1:1.3, all children were diagnosed with JIA, average age 10.5 years with range 2-18.27 children were registered with an NHS dentist with the exception of one child with a private dentist.26 children had seen a dentist at least annually and one child in the past 2 years. 2 children, one aged 16, were not registered with a dentist because their parents didn't think it was important.11 children had 25 fillings in total, 9 of these children were not supervised during dental hygiene.13 children admitted to drinking sugary drinks daily and had 16 dental fillings.None of the children admitted to smoking.Conclusions: Whilst our audit showed that most children were registered with a dentist and were reviewed annually, only 1 child had been offered sealant and fluoride varnish.The NHS advises that children with chronic medical conditions can be seen either by their NHS dentist or by the local Community specialist dental service which can be accessed by referral from their rheumatology department or NHS dentist.None of the children were seen by the specialist dental service.We have developed an information leaflet informing parents and children with JIA of the importance of dental health explaining the benefits of both sealant and fluoride for teeth.

In the UK, access to anti-TNF therapies for the treatment of rheumatoid arthritis (RA) is standardized by National Institute for Clinical Excellence guidance. Certolizumab pegol (CZP) studies in RA demonstrate that patient response to therapy at 12 weeks predicts clinical outcome at 1 year. In the UK, CZP is available via a Patient Access Scheme (PAS), providing CZP free for the first 12 weeks. This analysis examines persistency and potential cost savings realised with a 12 week CZP decision. A retrospective analysis examined 2,744 patients receiving CZP between March 2010 and March 2012 from Healthcare at Home, a UK home health care service provider. Persistence was defined as patients (%) continuing to receive CZP deliveries, calculated at specific time points. Treatment start was first delivery date and patients were censored according to this. A simple cost analysis was performed. At 13, 26, 39 and 52 weeks, persistence rates were 93%, 79%, 70% and 65% in naive (no prior anti-TNF) and 88%, 68%, 56% and 48% in switch (≥1 prior anti-TNF) patients respectively. Analyzing first-line biologic drug costs only, the NHS would save £2,363.14/patient in the first year if CZP were used instead of adalimumab (assuming similar persistence); largely due to the PAS. Stopping treatment for non-responders at Week 12 (CZP) vs Week 24 (adalimumab), could allow the UK NHS to re-invest £ 2145/patient. In this UK cohort, CZP persistence was higher in naive pts. Reinforcing a 12 week treatment decision could result in more efficient spend on drugs and rapid initiation of alternative treatment in non-responders.

OBJECTIVES National Institute for Health and Clinical Excellence (NICE) guidelines for anti-tumour necrosis factor (TNF) in rheumatoid arthritis (RA) state that two pre-assessments of Disease Activity Score (DAS28) should be performed a month apart. We performed a retrospective audit of data from six centres to determine the stability of DAS28 between assessments, and the proportion of patients still satisfying eligibility criteria at baseline. METHODS All RA patients assessed for anti-TNF from six centres had their pre-assessment DAS28 (DAS-1) compared with their baseline DAS28 (DAS0) using paired t-tests, and a similar analysis for the components of the DAS28. Patients who were no longer eligible for anti-TNF at DAS0 were noted. RESULTS Six hundred and seventy-nine RA patients showed no significant change in the DAS28, with a mean DAS-1 of 6.74 and DAS0 of 6.73. (P = 0.86). Of the patients, 97.2% fulfilled the UK eligibility criteria at DAS0. Comparison of the individual components of the DAS28 between the two pre-assessment dates showed that there was no significant difference between either the numbers of swollen joints or the erythrocyte sedimentation rate (ESR), but there was a significant increase in the numbers of tender joints of 1.41 (P < 0.001) and in the visual analogue scale (VAS) of 4.22 (P < 0.001). DISCUSSION The overwhelming majority of patients who fulfil eligibility criteria for anti-TNF drugs 1 month prior to baseline also fulfil the criteria at baseline. There is no significant change in the DAS28 over the month waiting to go onto anti-TNF therapy. A single assessment of the DAS28 would suffice to enable patients to go on to anti-TNF treatment.