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Background: Treating Rheumatoid Arthritis (RA) to an a priori defined disease activity target (T2T) is recommended in EULAR guidelines. This involves a step-up approach in which it is first attempted to achieve the target with a combination of conventional synthetic (cs) DMARDs. Baricitinib is a JAK1/JAK2-inhibitor approved for treatment of patients suffering from RA. EULAR and ACR guidelines currently position JAK1/JAK2-inhibitors and bDMARDs at the same level in the therapeutic treatment sequence for csDMARD Inadequate Responders (IR). Cost-effectiveness assessment of different T2T strategies, especially ones including new treatments, and integrating health economic considerations is of importance to the decision-making process as it incorporates the societal perspective in the longer run. Objectives: To compare the cost-effectiveness of the previously evaluated DREAM T2T strategy csDMARD combination therapy (csDMARDs)→ first bDMARD (adalimumab)→ next bDMARD (TNFi/non-TNFi) with the comparable strategy in which baricitinib is placed instead of adalimumab in csDMARDs IR using a Markov model. All analyses were performed from the societal perspective. Costs and effects over five years were compared between the two strategies to provide insight into the differences in economic considerations between treating patients with strategies including either JAK1/JAK2-inhibitor (baricitinib) or 1st bDMARD (adalimumab). Methods: A Monte Carlo microsimulation model was developed to conduct cost-utility analysis from the societal perspective over 5 years. Health states were based on the DAS28-ESR categories. Effectiveness of baricitinib was retrieved from clinical trials (1) and corrected for differences between RCT and real-world setting. Effectiveness of all other treatments, health state utilities, medical costs, and productivity loss were retrieved from DREAM cohorts (2) and the Dutch Institute for Health. Annual discount rates of 1.5% for utility and 4% for costs were used, as advised in Dutch guidelines. All analyses were run using probabilistic sensitivity analysis (PSA) to incorporate uncertainty around all parameters and assess result robustness. Results: PSA results showed the baricitinib strategy yielded lower costs and higher utility over a 5-year period and is cost-effective and dominant over the DREAM T2T strategy. Scenario analyses showed the baricitinib strategy to be cost-effective in both the moderate and severe at baseline RA populations analysed together and separately. CI= 95% Confidence Interval, QALY = Quality-Adjusted Life Year, ΔC = Cost difference, ΔE = Effect Difference, ICER = Incremental Cost-Effectiveness Ratio Conclusion: Results suggest the use of a JAK1/JAK2-inhibitor (baricitinib) instead of a 1st bDMARD (adalimumab) in a T2T strategy is cost-effective in treating RA patients. References: [1] Taylor, P. C., Keystone, E. C., van der Heijde, D., Weinblatt, M. E., del Carmen Morales, L., ... & Arora, V. (2017). Baricitinib versus placebo or adalimumab in rheumatoid arthritis. New England Journal of Medicine, 376(7), 652-662. [2] M., Versteeg, G. A., Vonkeman, H. E., Ten Klooster, P. M., Kuper, H. H., ... & van de Laar, M. A. (2016). Initial combination therapy versus step-up therapy in treatment to the target of remission in daily cl. Steunebrink, L. inical practice in early rheumatoid arthritis patients: results from the DREAM registry. Arthritis Research & Therapy, 18(1), 60. Disclosure of Interests: Celine van de Laar: None declared, Martijn Oude Voshaar: None declared, WALID FAKHOURI Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Liliana Zaremba-Pechmann Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Francesco de Leonardis Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Inmaculada De La Torre Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Mart van de Laar Grant/research support from: Eli Lilly, Pfizer, Merck, AbbVie and Janssen Cilag, Consultant for: Sanofi Genzym, Eli Lilly, Pfizer, Merck, Abbvie and Janssen Cilag, Speakers bureau: Eli Lilly, Pfizer and Janssen Cilag

Objectives To assess the long term efficacy and optimization of Infliximab (IFX) in refractory Uveitis of Behcet Disease (BD) Methods Multicentre study of Uveitis associated-BD refractory to conventional immunosupressive drug. Ocular inflammation was evaluated with “SUN criteria” (Am J Ophthalmol 2005;140:509–516) and the macular thickening with OCT. Results are expressed as mean±SD or median [IQR] (comparison, Wilcoxon test) Results We studied 100 patients/180 affected eyes (54M/46W), mean age 40.7±10.1. The ocular pattern was panuveitis (n=62), posterior (27) and anterior uveitis (11). Before IFX they received iv MP (28), cyclosporine (75), azathioprine (56), metotrexate (43) and others (33). IFX dose ranged between 3–5mg/kg/4 or 8 weeks. In patients in remission IFX was optimized (n=28) or stopped (n=20). Conclusions IFX is an effective long term-treatment in refractory Uveitis of BD. Optimization and even discontinuation of IFX after remission is possible. Disclosure of Interest None declared

Objectives To evaluate the efficacy of adalimumab (ADA) in short and long term follow-up in refractory uveitis of Behcet9s disease (BD) Methods Multicenter study. Ocular inflammation was evaluated according to “SUN working Group” (Am J Ophthalmol 2005;140:509–516), and the macular thickening with OCT. A comparison was carried out between baseline, and follow-up visits. Results are expressed as mean±SD or median [IQR]. Continuous variables were compared with Wilcoxon test. Results We studied 74 patients/132 affected eyes (39M/35W); mean age 38.7±11.3. The ocular pattern was panuveitis (n=45), posterior uveitis (n=14), anterior uveitis (n=14) and intermediate uveitis (n=1). Before ADA, systemic treatment with corticosteroids, iv metilprednisolone (n=23), Cyclosporin A (58), azathioprine (33), metotrexate (31) and other drugs (28) was used. The dose of ADA was 40 mg/2 weeks/ sc in monotherapy (n=22) or combined (n=52). Most patients showed a rapid and progressive improvement (TABLE). The 24 patients (37 affected eyes) with CME showed a significant improvement. ADA was optimized in 23 (31.1%) that were in remission for 15.3±9 months. Interval of administration was increased to 3 (n=6), 4 (13), 5 (1), 6 (1) and 8 weeks. After a mean follow-up of 13.0±9.7 months after optimization, 21 patients were stable and 2 had a severe flare. In 4 patients ADA was stopped after 35.2±9.3 months in remission. The main adverse effects observed were lymphoma (n=1), pneumonia (1), and 2° bacteriemia by E. Coli (1) Conclusions ADA was effective in short and long-term follow-up in refractory uveitis associated to BD. Optimization or even suspension of ADA is possible. Disclosure of Interest None declared