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ii132 Wednesday 26 April 2017
POSTER VIEWING II
Methods: A short survey about GC use popped up when UK users
viewed posts discussing steroids on healthunlocked.com. Responders
were eligible if they were currently taking, or had taken GCs within the
last month. Within the survey, responders had to score the importance
of listed side effects from 1 to 10, with 10 being of high importance to
them. The side effects shown in Table 1 were listed alphabetically, with
examples or descriptions as required. Side effects were ranked by
median ranking (largest to smallest) and then IQR (smallest to largest)
for those with the same median. The scores were categorized as low
(scores 1?3), medium (scores 4?7) and high (scores 8?10) importance.
Results: There were 604 responders who completed the survey. The
majority were over 50 years old (81%) and female (86%). When ranked
the side effect of most importance to responders was weight gain
(median score� IQR 6, 10) followed by insomnia and moon face with
equal median score (8) and IQR (5, 10). Several side effects had the
same median score of 8, but distribution across categories varied.
Three clinically serious side effects: cardiovascular disease, diabetes
and infection, were ranked of lower importance but had wide ranging
scores (median score� IQR 1, 10). Acne was of least importance to
responders (median score� IQR 1, 6) (Table 1).
Conclusion: The three most highly rated side effects were not
clinically serious but remained important to patients, perhaps reflecting their impact on quality of life and their high prevalence. The
importance of these less serious but potentially high impact side
effects should be taken into consideration when discussing treatment
options and planning future GC safety studies.
209 TABLE 1. Median, interquartile range, rank and categories of side effect scores.
Side effect
High
Medium
Median Rank Low
(IQR)
(score 1?3) (score 4?7) (scores 8?10)
N (%)
N (%)
N (%)
Weight gain
Insomnia
Moon face
High blood pressure
Reduced bone strength
Eye disease
Cardiovascular disease
Diabetes
Infections
Changes in mood
Skin changes
Palpitations
Indigestion
Acne
9
8
8
8
8
8
8
8
8
7
7
7
6
1
(6,
(5,
(5,
(4,
(4,
(3,
(1,
(1,
(1,
(5,
(5,
(4,
(3,
(1,
10)
10)
10)
10)
10)
10)
10)
10)
10)
9)
9)
9)
8)
6)
1
2
2
4
4
6
7
7
7
10
10
12
13
14
74 (12.3)
75 (12.4)
125 (20.7)
150 (24.8)
133 (22)
164 (27.2)
216 (35.8)
206 (34.1)
182 (30.1)
110 (18.2)
109 (18)
125 (20.7)
152 (25.2)
359 (59.4)
145 (24)
210 (34.8)
149 (24.7)
138 (22.8)
134 (22.2)
93 (15.4)
56 (9.3)
86 (14.2)
116 (19.2)
239 (39.6)
214 (35.4)
212 (35.1)
276 (45.7)
138 (22.8)
385
319
330
316
337
347
332
312
306
255
281
267
176
107
(63.7)
(52.8)
(54.6)
(52.3)
(55.8)
(57.5)
(55)
(51.7)
(50.7)
(42.2)
(46.5)
(44.2)
(29.1)
(17.7)
Disclosure statement: The authors have declared no conflicts of
interest.
210. SWITCHING TO BIOSIMILARS: AN EARLY CLINICAL
REVIEW
Roberta Rabbitts, Teresa Jewell, Kui-leng Marrow, Clare Herbison
and Catherine Laversuch
Rheumatology, Musgrove Park Hospital, Taunton, UNITED
KINGDOM
Background: Currently there is no clear guidance on how or when to
switch patients from biologic medications to biosimilar medications
but instead it is recommended on a case by case basis. It is important
to pursue the most safe, efficacious and cost-effective treatments for
our patients. At Musgrove Park Hospital in the South West of England
the decision was made to switch all patients from the biologic
Etanercept to the Etanercept biosimilar, Benepali. The patients were
informed by letter and then Healthcare at Home were involved to
provide support for the new pen injection device. As far as we are
aware, we are the first hospital worldwide to globally switch all patients
on Etanercept biologic to Benepali, Etanercept biosimilar. It therefore
was important for us to have a preliminary look at our outcomes.
Methods: A list of all patients on biologic or biosimilar medicines was
created by our specialist nurses. All patients prescribed Etanercept
biologic or biosimilar were identified. We performed data collection by
looking through our records for all patients on Etanercept. Data were
collected on their diagnosis, pre switch outcome measures and then
post switch outcome measures (DAS28, number of tender and swollen
joints, BASDAI scores, HAQ). Switch-over dates were obtained from
the patients and Healthcare at Home. Patients completed a biologic
follow-up questionnaire at review assessing both the new pen device
and their experiences.
Results: As of mid-August 2016 we had 83 patients taking Benepali.
Just over a third of these had Rheumatoid Arthritis, 19% had Psoriatic
arthritis with the remainder a mix of Ankylosing Spondylitis,
Seronegative Spondyloarthropathies and Adult Juvenile Idiopathic
Arthritis. 13 patients were started directly on Benepali, 4 of these have
had a good response and 2 have not found it beneficial. The remainder
are still in early stages and yet to be assessed. 70 patients were
switched from Etanercept to Benepali starting at the beginning of April
2016. 44 of these patients have now been reviewed with 84% patients
having continued efficacy with Benepali. 3 patients have paused
treatment due to infection or planned surgery. 5 patients have failed on
Benepali.
Conclusion: From our early clinical review we are reassured that our
patients continue to have a good response from the biosimilar
Benepali. We have not reported any adverse safety events in this
time period. Patients have reported that the new pen device is easier
to use and they report less injection side reactions. It is vital that we
continue surveillance of these patients to ensure longer term safety
and clinical effectiveness data is collected and this includes the use of
registers such as the BSRBR.
Disclosure statement: The authors have declared no conflicts of
interest.
211. PROGRESSIVE RESISTANCE TRAINING IMPROVES
FUNCTION IN EARLY AND ESTABLISHED INFLAMMATORY
ARTHRITIS: EXPERIENCE FROM A DISTRICT GENERAL
HOSPITAL
Klara Morsley, Berna Berntzen, Lisa Erwood, Toby Bellerby and
Lyn Williamson
Rheumatology, Great Western Hospital, Swindon, UNITED
KINGDOM
Background: Up to half of rheumatoid arthritis (RA) patients develop
rheumatoid cachexia which is associated with multiple adverse effects
on patient body composition, function and mortality. These changes
occur despite improvements in drug treatment for RA. Progressive
resistance training (PRT) can improve these outcomes but is not widely
used outside of a research setting. The aim of this study was to explore
the feasibility and effectiveness of providing PRT to patients in a
district general hospital within the constraints of existing resources.
Methods: Patients attending rheumatology clinic were invited to
participate in a weekly PRT class for 6 weeks under the supervision of
a physiotherapist. Outcome measures included: body composition
measures (waist and hip circumference, weight, percentage body fat);
functional measures [grip strength, sit to stand over 60 seconds
(STS60), single leg stance (SLS), Health Assessment Questionnaire
(HAQ)]; mood, fatigue and disease activity measures [sleep scale,
hospital anxiety and depression scale (HAD), Functional Assessment
of Chronic Illness Therapy (FACIT-F1), pain visual analogue scale].
These were measured at baseline and at 6 weeks.
Results: 83 patients completed the programme (60% female, mean
age 51.2 years), of whom 34.9% had early RA. Improvements were
seen in multiple measures both in all patients and in the early RA
patient group (Table 1), and were not affected by age or gender.
Conclusion: Patients with both early and established inflammatory
arthritis benefited from a 6 week PRT programme provided within an
NHS setting. Although further work is needed to look at the long term
effects, we suggest this intervention should be more widely available.
211 TABLE 1. Outcome measures before and after PRT.
All patients (n � 83)
Early RA (n � 29)
Mean change (SD) P-value Mean change (SD) P-value
Waist (cm)
Hip (cm)
% body fat
Right grip (kg)
Left grip (kg)
STS60
HAQ
HAD-anxiety
HAD-depression
Total sleep score
FACIT-F1
VAS (100)
1.58 (7.33)
1.00 (4.60)
0.71 (8.22)
3.04 (6.99)
3.13 (4.97)
4.74 (6.02)
0.24 (0.62)
0.94 (2.95)
0.85 (2.81)
1.17 (2.30)
2.21 (12.11)
7.75 (20.21)
<0.0001
0.005
<0.0001
0.002
0.0002
0.006
<0.0001
0.002
0.012
<0.0001
0.026
0.003
3.02 (8.39)
0.01 (4.97)
1.82 (7.47)
2.36 (3.26)
3.07 (4.65)
4.86 (5.24)
0.24 (0.66)
0.82 (2.48)
0.39(2.47)
1.21 (2.35)
0.35 (10.57)
4.46 (21.69)
0.001
0.384
0.006
0.017
0.028
<0.0001
0.002
0.105
0.258
0.012
0.86
0.741
Disclosure statement: The authors have declared no conflicts of
interest.
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