P021 Rheumatology shielded patients, hospitalised COVID-19 and outcomes in Essex: an audit across Mid and South Essex and Barking, Havering and Redbridge Hospitals NHS Trusts

Background/Aims 

Shielding measures were implemented within the United Kingdom in an attempt to slow the rate of COVID-19 infections, with shielding letters being sent to extremely vulnerable patients. This included rheumatology patients on immunosuppressive therapies sufficient to increase their risk of infection.

Methods 

This was a retrospective audit assessing the number of rheumatology patients within the Mid and South Essex NHS Foundation Trust (MSE Trust) and Barking, Havering and Redbridge University Trust (BHR Trust) who were sent shielding letters. We audited how effective these measures were in preventing COVID-19 infection during the shielding period (up to 1^st July 2020). Risk criteria from NHS Digital and the British Society for Rheumatology (BSR) were used by individual departments within these Trusts to identify the relevant patients. We audited from case records demographic details, rheumatological diagnoses, therapies and associated co-morbidities in these patients.

Results 

A total of 5,876 high risk patients within these Trusts were identified and sent shielding letters: 4,914 within the MSE Trust and 962 patients within the BHR Trust. As seen in Table 1, of these 5,876 patients, 28 (0.48%) were hospitalised with positive tests for COVID-19: 23 of the 4,914 (0.47%) in MSE Trust and 5 of the 962 (0.52%) in BHR Trust. Of the 28 COVID-19 admissions, 10 died (36%). The number of rheumatology patients that developed COVID-19 as a proportion of all patients admitted across these two Trusts was 0.76% (28 out of 3,695). P021 Table 1:

AB1178 AN AUDIT OF ORIGINATOR ADALIMUMAB TO BIOSIMILAR SWITCH IN TWO HOSPITALS

Background:

Biological drugs have revolutionized the treatment of immune-mediated inflammatory diseases (IMIDs). Current guidelines reserve these drugs for patients with severe refractory disease.

Biologic drugs are expensive, but as they reach patent expiry, the introduction of lower-cost biosimilars reduces their impact on health care budgets. It is estimated that NHS England could save £300 million by 2021 following the recent launch of adalimumab biosimilars [1]. As part of this process, there has been a mandatory switch of originator adalimumab to biosimilar adalimumab throughout the U.K.

Objectives:

To evaluate the impact of the switch to biosimilar adalimumab in individuals with inflammatory arthritis at two NHS trusts in the East of England and calculate the proportion and reasons for switch back to originator adalimumab or a second biosimilar at 12 weeks.

Methods:

Both hospitals ran dedicated ‘switch’ clinics. All patient records were reviewed retrospectively.

Results:

855 patients with different IMID switched from originator to biosimilar over 13 months. At 12 weeks, 730 patients (85%) maintained the switch, 71 patients (8.7%) switched back to the originator, and 54 patients (6.3%) switched to other biosimilars of the same drug.

Table 1.

Primary outcome analysis of switching from originator to adalimumab biosimilar

DiagnosisTotal patient switched from originatorAverage duration (year) of use of originator before bio switch (for patients continue using bio switch)Total patients continuing (At 12 weeks)Average duration (year) of use of originator before bio switch (for patients switched back to originator)Total patients switched back to originator or other biosimilarRheumatoid Arthritis3567.9314 (88%)4.942 (12%)Axial Spondyloarthritis2606.4213 (82%)4.547 (18%)Psoriatic Arthritis2185.9187 (86%)2.931 (14%)Juvenile Arthritis163.714 (88%)4.52 (12%)Others52.22 (40%)0.83 (60%)Total8557.0730 (85%)4.2125 (15%)Table 2.

Reasons for back to originator or another biosimilar

Reasons for back to originator or another biosimilarNumber back for IntoleranceNumber back for InefficacyPainful injection69BASDAI/Spinal Pain13Pain/Others19TJC, SJC, VAS4Rash/Allergic reaction5DAS3Headache5PsARC2Nausea4No Detail1Total102Total23%82%18%

Conclusion:

Switching to a biosimilar was successful in the vast majority of patients and is associated with significant saving. The list prices for originator Adalimumab is £9,155/person/year and £8,238/person/year for biosimilar Adalimumab respectively [2]. By switching we will save approximately £719,402 per annum (9.2% cost reduction).

References:

[1]NHS England. NHS set to save record £300 million on the NHS’s highest drug spend 2018 [cited 2018 November 30].https://www.england.nhs.uk/2018/11/nhs-set-to-save-record-300-million-on-the-nhss-highest-drug-spend/

[2]https://bnf.nice.org.uk/medicinal-forms/adalimumab.html

Disclosure of Interests:

Rifat Mazumder: None declared, Marianne Loke: None declared, Chetan Mukhtyar: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Emese Balogh: None declared, Emerald Sekaran: None declared, Mushfika Sultana: None declared, Mabel Odonkor: None declared, Karen Miles: None declared