Incidence of joint replacement surgery among biologics and non-biologics treated patients with rheumatoid arthritis: a propensity score matched cohort study from denmark

Background Biologics have improved several clinical, patient-reported and radiological outcomes in patients with rheumatoid arthritis (RA), but little is known about the potential impact on the need for joint replacement surgery.Objectives To investigate the incidence of joint replacement surgery among biologics treated compared with biologics naïve patients with RA.Methods A nationwide, register-based propensity score matched cohort study. RA patients registered between 2006 and 2016 in the DANBIO register with a disease duration ≤ 2 years were identified. Patients initiating their first treatment series with biologics were followed up to 10 years for a first joint replacement of the hip, knee, shoulder, elbow and finger/wrist. Biologics naïve patients were followed up for the same outcome from their first clinical visit registered in DANBIO. Following a 1:n propensity score matching, Cox-models were undertaken to calculate the hazard ratio (HR) for a first joint replacement surgery among biologics compared with non-biologics treated RA patients. Further, subgroup analyses based on within-strata propensity score matched patients were carried out. All information on surgical outcomes was obtained in the Danish National Patient Registry.Results In total, 1187 biologics treated were matched with 3666 non-biologics treated patients (See Table). View this table:Abstract THU0059 – Table1 Baseline characteristics of biologics treated and biologics naïve patients with rheumatoid arthritis and a disease duration < 2 years registered in DANBIO between 2006 and 2016.During follow-up, 43 biologics-treated and 124 naive patients had a first joint replacement surgery corresponding to an overall HR of 0.95 (0.65 to 1.40) for biologics treated compared with naïve patients (Figure 1). Patients with a DAS28-CRP < 4.6 at start of follow-up (low and moderate disease activity)1, biologics treated had a lower risk of joint replacements compared with biologics naïve patients.Conclusion In this nationwide Danish cohort study, there was no difference in the incidence of joint replacement surgery among newly diagnosed RA patients selected for treatment with biologics compared with patients naïve to biologics.Abstract THU0059 – Figure 1 References [1] Fleischmann, et al. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open 2017;3:2–6.Disclosure of Interests René Cordtz: None declared, Samuel Hawley: None declared, Daniel Prieto-Alhambra Grant/research support from: Grants from Amgen, UCB Biopharma and Servier outside the submitted work, Consultant for: UCB Biopharma, Speakers bureau: Amgen, Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals, Søren Overgaard: None declared, Anders Odgaard: None declared, Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals.