Ab0445 characteristics of first-line upadacitinib initiators and factors contributing to prescribing upadacitinib as first-line b/tsdmard

Background EULAR guidelines recommend switching to or adding a b/tsDMARD in patients with rheumatoid arthritis (RA) who do not respond or have an inadequate response to csDMARDs. Traditionally, TNF inhibitors (TNFi) are prescribed as the first b/tsDMARD. In Dec 2021, the upadacitinib (UPA) label in the US was updated to restrict use to those who have had an inadequate response or intolerance to one or more TNFi. Objectives In the period prior to the UPA label change in the US (through Jan 2022), to (1) compare characteristics of patients with RA receiving UPA as first b/tsDMARD with those who initiated TNFi as their first b/tsDMARD, and (2) explore the reasons why UPA was chosen as first-line advanced therapy. Methods Using CorEvitas RA registry data from Aug 2019 to Jan 2022, patients who initiated UPA or TNFi at or after enrollment in the registry with no history of prior b/tsDMARD use were evaluated. The patients’ providers indicated which factors (they could choose more than one) contributed to prescribing UPA as first-line advanced therapy based on medical record chart review. Results Few differences in demographics, comorbidities, and disease activity at initiation were observed between the 815 TNFi initiators and 142 UPA initiators identified. UPA initiators were older (mean [SD] age 58.9 [12.8] vs 56.7 [13.9] yrs), had a higher proportion of White patients (87% vs 83%), and were less likely to be working (44% vs. 53%), and have private insurance (73% vs. 68%). UPA initiators had more frequent history of cardiovascular disease (16% vs 10%), joint deformity (17% vs 12%), and subcutaneous nodules (13% vs 10%), but less frequent history of anxiety/depression (29% vs 34%) than TNFi initiators. UPA initiators had greater disease severity, including mean CDAI (23.7 [14.9] vs 19.0 [13.0]), and tender (8.4 [7.7] vs 6.6 [6.7]) and swollen (6.1 [5.1] vs 4.3 [5.1]) joint counts, self-reported pain (54.5 [28.7] vs 50.3 [28.3]), and proportion with morning stiffness (89% vs 85%). UPA initiators were more likely to have a history of multiple csDMARDs (43% vs 35%), monotherapy b/tsDMARD initiation (32% vs 22%) and use of NSAIDs (53% vs 48%). For 142 patients initiating UPA as first-line, 34 providers (87% response rate) indicated major factors in the choice of prescribing UPA as first-line advanced therapy were the patient’s level of disease activity (75%), patient’s disease progression (61%), patient preference (51%), and patient’s disease profile (43%). These reasons contributed to any part of the prescription decision in 99%, 96%, 77%, and 79% of patients, respectively. Oral delivery was indicated as a contributing factor by almost all (91%) of the 109 patients that were prescribed UPA as first-line therapy and indicated patient preference was a factor in prescribing UPA. Side effects were not a concern when deciding to prescribe UPA in at least 50% of the patients included in this study. Conclusion In a real-world cohort of patients with RA initiating a first-line b/tsDMARD, those who received UPA were more likely to have previously failed multiple csDMARDs, to initiate as monotherapy, and to have had greater disease activity based on both physician and patient measures compared to patients who received TNFi. Clinical factors including disease activity, disease progression, and disease profile influenced the prescribing decision by providers as well as patient preference. References NIL. Acknowledgements AbbVie and the authors thank the patients, study sites, and investigators who participated in this study. AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Disclosure of Interests Whitney Krueger Shareholder of: full-time employee of AbbVie and may hold AbbVie stock and/or stock options and patents, Employee of: full-time employee of AbbVie and may hold AbbVie stock and/or stock options and patents, Leslie Harrold Shareholder of: employee and shareholder of CorEvitas, Speakers bureau: Bristol Myers Squibb, Consultant of: AbbVie, Bristol Myers Squibb, Roche, Employee of: employee and shareholder of CorEvitas, Adam Sima Employee of: employee of CorEvitas, LLC (formerly Corrona, LLC). CorEvitas is supported through contracted subscriptions with multiple pharmaceutical companies. The presentation was a collaborative effort between CorEvitas and AbbVie with financial support provided by AbbVie, Thomas Eckmann Employee of: employee of CorEvitas, LLC (formerly Corrona, LLC). CorEvitas is supported through contracted subscriptions with multiple pharmaceutical companies. The presentation was a collaborative effort between CorEvitas and AbbVie with financial support provided by AbbVie, Ryan Kilpatrick Shareholder of: full-time employee of AbbVie and may hold AbbVie stock and/or stock options and patents, Employee of: full-time employee of AbbVie and may hold AbbVie stock and/or stock options and patents.