FRI0518 Incidence, characteristics and management of giant cell arteritis in france: a study based on national health insurance claims data

Background Giant cell arteritis (GCA) is an immune-mediated, primary systemic vasculitis that affects large and medium-sized arteries. GCA may cause vision loss in up to 20% and requires long term glucocorticoids (GCs). There are currently few data available in France on the epidemiology, patients’ (pts) characteristics, diagnosis and management of GCA in a real-world setting. Objectives The objectives of this study were to address these questions using Health insurance claims data. Methods This retrospective cohort study used the EGB (Echantillon Generaliste des Beneficiaires) database which is a 1% random and representative sample of the French national Health insurance system. EGB contains anonymous demographic and comprehensive medical data on conditions with long-term disease (LTD) status, hospitalizations and reimbursement claims for medications dispensed in the community. The study used the data collected between January 1, 2007 and December 31, 2015. Inclusion criteria were: 1) age ≥50 years; 2) hospitalisation for GCA or LTD status for GCA (ICD-10 codes: M31.5/6); and 3) at least 4 drug dispensing of oral GCs within 6 months around the index date. The index date was defined as the date of 1 st occurrence of GCA code and cases were considered as incident if the GCA code first occurred after ≥2 years of follow-up. Demographics, co-morbidities, diagnostic tests and therapies were analysed. A treatment sequence was defined as the start of a new drug or the resumption of the same drug after a stop ≥3 months. Annual incidence was calculated by using the people recorded in the EGB as denominator. Results Among the 7 52 717 pts recorded in the EGB, 241 pts fulfilled our criteria. Around 24 pts were newly diagnosed/year with an annual incidence of 7 to 10/100,000 people≥50 years-old. 72% of the 241 pts were females, mean age was 77.5 (±8.9) years, mean follow-up 3.7 (±2.6) years. In the 12 months before index date, 74.3% of the pts had at least 1 proxy for hypertension, 39.4% for depression/insomnia and 33.6% for osteoporosis. After index date, temporal artery biopsy (TAB) was performed in 43.2%, high-resolution Doppler ultrasound in 35.3% and positron emission tomography (PET) in 11.6%. Among the 235 pts (97.5%) who had at least 1 drug dispensing of oral GCs, 198 pts (84.3%) used only GCs while 37 (16.7%) also received 1 to 3 adjunctive agents. Mean 1 st GCs sequence duration was 17.2 months (±16.5) in 96.6%. 95 pts (40.4%) had a 2nd sequence, i.e. resume GCs and or start a new drug for a duration of 6.7 months (±8.1) for GCS alone or 12.2 months (±8.8) for GCs+adjunctive drug. The most prescribed GCs-sparing agent was methotrexate (12.0%). Others were marginal: hydroxychloroquine 7 pts, azathioprine 4, cyclophosphamide 1, infliximab 1, adalimumab 2 and etanercept 1 pt. Conclusions These real-world data indicate an incidence of GCA in France of 7 to 10 cases/100,000 people≥50 years-old and underline that most patients with GCA are treated with GCs alone whereas adjunctive agents, mainly methotrexate, are given to 17% of patients. The utilisation of TAB in only half of the patients might reflect a shift towards increasing use of imaging techniques to diagnosed GCA. Disclosure of Interest V. Devauchelle Pensec: None declared, E. Hachulla: None declared, M. Paccalin: None declared, S. Gandon Employee of: Roche SAS, I. Idier Employee of: Chugai Pharma France, M. Nolin: None declared, M. Belhasen: None declared, A. Mahr: None declared