1 Long Term Originator Infliximab Treatment Is Predictive of Retention

1 Long Term Originator Infliximab Treatment is Predictive of Retention in Stable Rheumatic Disease Patients in Canada Philip Baer (Scarborough); Majed Khraishi (Memorial University of Newfoundland, St. John's); Marilise Marrache (Janssen Inc., Toronto); Emmanuel Ewara (Janssen Inc., Toronto) Objectives: To evaluate long-term retention patterns of stable rheumatic disease (RD) patients treated with REMICADE® (infliximab [IFX]). Methods: Using IMS Brogan’s™ database of private and public insurance claims data, our analysis included RD patients with: (1) first IFX claim between Jan 2008-May 2015; (2) no IFX claims 12 months prior to the initial claim; (3) ≥1 claim for any other drug 12 months after the initial IFX claim; and (4) ≥1 claim for any non-IFX drug 4 months after May 2015. Retention was measured at 12-month intervals and unadjusted odds ratios calculated at the 95% confidence interval within and between cohorts of RD patients. Within-group analysis compared 12 month retention by number of years on IFX. Analyses considered cohorts of patients according to age, gender, insurance type, and previous biologic experience. Results: A total of 1,672 had ≥2 years of claims history and had been on IFX for ≥1year. Within-group comparisons showed that a patient’s probability of being retained on IFX in subsequent 12-month periods increased concurrently with elapsed time on IFX. Patients on IFX for 2, 3, 4 and 5 years showed significantly higher retention in the subsequent year compared to patients on IFX for only 1 year (P < 0.05). Similar trends were observed for females, in the 19-64 age range, within naïve and experienced cohorts, and by those patients with private insurance coverage. Retention at 12-month intervals up to and including 5 years was significantly better at each interval for biologic-naïve vs experienced patients and public insurance vs private insurance patients in the between-group analyses. Conclusion: Real world patients treated with IFX have excellent long-term treatment retention. Longer time on IFX appears to predict better future retention, becoming statistically significant after 2 years. The results were robust and consistent amongst various subgroups of stable Canadian rheumatology patients. 2 Methotrexate Use in Patients: Self-Reported Coping Mechanisms Dawn Richards (Canadian Arthritis Patient Alliance, Toronto); Laurie Proulx (Canadian Arthritis Patient Alliance, Ottawa); Linda Wilhelm (Canadian Arthritis Patient Alliance, Midland); Nathalie Robertson (Canadian Arthritis Patient Alliance, Ottawa); Annette McKinnon (Canadian Arthritis Patient Alliance, Toronto); Janet Gunderson (Canadian Arthritis Patient Alliance, Glaslyn); Don Mohoruk (Canadian Arthritis Patient Alliance, Coquitlam) Objectives: Methotrexate is one of the first medications prescribed to manage inflammatory and other types of arthritis. This key medication is used with non-biologics or biologics. As people who live with arthritis, we know firsthand that many people have difficulties tolerating methotrexate, so do not use it as prescribed and may not benefit maximally from it. We asked people how they cope with taking their methotrexate so that we can build and share resources based on this information. Methods: CAPA drove this project with financial and in-kind support from many arthritis stakeholders. One Board member acted as project manager to construct an online survey. Methods to achieve input and feedback for the draft survey included phone calls and emails. Feedback was gathered from patients (members of the CAPA Board) and the survey was reviewed by a rheumatologist. Once finalized and agreed to, the survey was translated in to French. Subsequent distribution and promotion of the bilingual survey were achieved through CAPA’s efforts (email blast to membership, social media promotion on Twitter and Facebook) and with stakeholders’ help via online dissemination tools (and included efforts of other patient organizations, individual patients, and the Arthritis Society). Results: At the time of submission, over 250 respondents (88% female, 12% male) had participated in the online survey. Approximately 80% of responses were from Canada and most responses were from people living with rheumatoid arthritis. Nearly 50% of survey respondents indicated that they “do not like taking methotrexate, but it helps me manage my arthritis.” The most popular methods to tolerate methotrexate include switching from the pill form to an injectable form, taking methotrexate right before bed, and taking folic acid. Nearly 80% of respondents answered that they have not talked to their physician or pharmacist about finding the most appropriate solution for them with respect to taking methotrexate. An extensive analysis of the results will be presented. Conclusion: Using an online survey, CAPA learned from people living with arthritis about how they cope with taking methotrexate, a seminal medication used in the treatment of arthritis. The survey responses will be used to inform resources that are medically reviewed about managing to take methotrexate. Through sharing information from other patients, we hope that this will encourage others to try these tips or to have an honest conversation with their doctor or pharmacist to help them find their own most appropriate solutions. Recognized by the CRA Optimal Care Committee for Quality Improvements and Choosing Wisely. 3 The Objective Gap: A Survey of Patient and Health Care Professionals’ Priorities for Inflammatory Arthritis Treatment Ed Ziesmann (The Arthritis Society (Ontario Division), Toronto); Ahmad Zbib (The Arthritis Society, Toronto); Douglas Emerson (The Arthritis Society, Toronto) Objectives: More than one million Canadians live with inflammatory arthritis (IA). An online survey was provided to health care professionals (HCPs) and patients with IA across Canada to identify priorities in terms of treatment outcomes. Methods: Participants were surveyed online and asked a series of questions about the objectives for treatment and whether they felt that various aspects of coping with arthritis were adequately addressed in the clinical setting. Results: 235 patients and 108 HCPs responded to the survey. Patients and HCPs agreed that the impact of arthritis on the mind, family and the social and economic aspects of arthritis were not addressed well in clinical practice. Patients perceived that their physicians’ priorities were to limit the effect of the condition on their body (52%) and enable them to live an independent life (27%). Physicians perceived that their patients’ priorities were similar, 32% and 54% respectively. Patients were more likely than HCPs to identify pain relief as a priority following initiation of a biologic (39% and 15% respectively). HCPs were more likely than patients to prioritize getting on with a normal life (52% and 29% respectively) and reducing joint inflammation (24% and 8% respectively). Conclusion: Results suggest that patients and HCPs view the goals for care quite differently. People with IA are also looking for more support than the traditional clinical appointment is structured to provide. Further studies are needed that address the gap between how HCPs treating IA measure the progress of treatment, and how patients experience their disease. Recognized by the CRA Optimal Care Committee for Quality Improvements and Choosing Wisely. 4 Development of Guidelines for Radiographically-Guided Intra-Articular Steroid Injections in a Community Rheumatology Group Practice Raman Joshi (Brampton Civic Hospital, William Osler Health System, Brampton); Vandana Ahluwalia (William Osler Health System, Ontario Rheumatology Association, Brampton); Sangeeta Bajaj (William Osler Health System, Brampton); Tripti Papneja (William Osler Health System, Brampton); Nicholas DeSouza (New England School of Optometry , Boston); George Moawad (Wilfred Laurier University, Waterloo) Objectives: Radiographically guided steroid injections are procedures often requested by community-practicing Rheumatologists. The purpose of this study was to develop and establish a set of guidelines to determine the conditions in which radiographically-guided injections would be most beneficial for patients when compared to clinically-guided injections. Methods: All patients referred from a community-based Rheumatology clinic in Brampton for radiographically guided injections at Brampton Civic Hospital between January – December 2014 were identified. A subset of this group consisting of patients who had shoulder and knee injections was further sub-analyzed. The patients’ charts were retrospectively reviewed for data on gender, age, body mass index (BMI), diagnosis, injection history, injection location(s), type of steroid used, and dose of each injection. Follow-up data relating to the injection (patient status, improvements and complications following injection), as well as duration between re- injections were collected. For patients who had radiographically-guided shoulder and knee injections, data was also collected on prior medications, steroid injections to the joint and outcomes before radiographically-guided steroid injection. Results: A total of 118 patients had 134 injections. Patients tolerated the injections well with approximately 67% noting a benefit. Actual pain scores were recorded in <10% of patients and duration of benefit was quantified in 16% of patients. There was no significant difference between the different joints injected. Hip and shoulder joints that were injected with 80mg Depomedrol

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