THU0651 The influence of age, gender, employment status, or education on the choice of bio-similar vs. bio-original variant of the same bdmard in patients with ra or as starting biological therapy – real life data from the czech biologics registry attra

• Published in: Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 520
• Main Authors: Zavada, J., Nekvindova, L., Pavelka, K., Vencovsky, J.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2018
• Subjects: Age; Biological products; Employment; Etanercept; Gender; Immunotherapy; Infliximab; Maternity & paternity leaves; Monoclonal antibodies; Tumor necrosis factor-α; Czech Republic
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-eular.5559

BackgroundPerceptions on bio-originator (bo) and bio-similar (bs) biologics among HCPs and pts, as well administrative regulations or economic incentives may influence their utilisation in clinical practice. The ATTRA registry captures more than 95% of pts with RA and AS treated with biologics in the Czech Republic (CZ). Access to biological therapy in CZ is limited to about 30 authorised centres. Bs infliximab (INF) has been prescribed in CZ since 11/2013, and bs etanercept (ETA) since 1/2016 concurrently with bo INF and ETA. There has been no administrative regulation concerning the use of bs or bo in CZ.ObjectivesTo explore whether age, gender, employment status, or level of education influence the choice of bs vs. bo variant of the same bDMARD in pts with RA or AS starting bDMARD in CZ.MethodsData from the ATTRA registry on pts with RA or AS starting their first bDMARD between 11/2013 and 10/2017 were used. The start of bo vs. bs ETA, or bo vs. bs INF as the first bDMARD was the main outcome of interest. Multivariate logistic regression analysis was used to explore the impact of education, employment status, age and gender on the start of a first bDMARD after adjustment for disease characteristics, and the bDMARD molecule.Results560 pts started ETA (22.6% bo, 14.2% bs) or INF (9.7% bo, 53.5% bs) in the study time frame. In the multivariate model (table 1) pts starting ETA (ref. INF) had lower odds to receive a bs (OR 0.11, CI95% 0.07–0.17), and pts with primary education (vs. secondary or tertiary) had higher odds to receive any bs (OR 1.84, CI95% 1.08–3.13). When we performed separate analyses for pts treated in academic/public hospitals (n=314), the adjusted OR for pts with primary education was 0.78 (CI95% 0.37–1.64), while in private centres (n=246) the OR was 5.32 (CI 95% 2.32–12.16). When we introduced an interaction term for type of practice x level of education, the adjusted OR for pts with primary education in private centres was 2.26 (CI95%, 1.14–4.46, p=0.019).Abstract THU0651 – Table 1 ParametersOR (95% CI)p-value HDA vs. REM+LDA+ MDA (acc to DAS28/ASDAS)0.94 (0.50; 1.77)0.859CRP [mg/l]1.00 (0.99; 1.01)0.770HAQ1.16 (0.75; 1.78)0.513AS (vs. RA)1.40 (0.81; 2.40)0.229ETA (vs. INF)0.11 (0.07; 0.17)<0.001Age at start of 1st bDMARD1.01 (0.99; 1.04)0.271Disease duration1.01 (0.98; 1.04)0.693Female0.78 (0.48; 1.26)0.316Primary education (vs. Secondary or Tertiary)1.84 (1.08; 3.13)0.024Sick leave (vs. employed)1.61 (0.68; 3.82)0.283Disability pension (vs. employed)0.74 (0.36; 1.54)0.421Old age pension (vs. employed)0.61 (0.28; 1.31)0.205Unemployed (vs. employed)1.08 (0.48; 2.42)0.845Maternity leave/student (vs. employed)1.48 (0.43; 5.08)0.529ConclusionsWe found that in private centres providing biological therapy in CZ, pts with primary education had higher adjusted odds to obtain bs as the first bDMARD. We cannot exclude that different pt characteristics and residual confounding may have been involved. The interpretation is complex and related not only to perception of bs by HCPs and pts, but also to unmeasured economic incentives and other factors.AcknowledgementsThis work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organisation 0 23 728Disclosure of InterestNone declared