Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.

BackgroundCurrently available evidence indicates that a single switch from a bio-originator to one of its biosimilars is safe and effective and has cost benefits to the National Health Systems. However, there is some reluctance to switch patients due to lack of real-world data and differences between patients treated in the setting of real clinical practice and those of clinical trialsObjectivesWe aimed to investigate the efficacy and safety of Etanercept-biosimilar (SB4), in a non-medical switch in patients with inflammatory arthritis (IA)MethodsAt Cabueñes Hospital a non-medical switch from Etanercept (ETN) to SB4 was carried out in March 2018. Inflammatory arthritis patients (rheumatoid arthritis (AR), psoriatic arthritis (APS), axial spondyloarthritis (AS), juvenile idiopathic arthritis (JIA)) were included in this single-center retrospective observational study from March 2018 to December 2018. Reasons for SB4 withdrawal were categorized as lack of effect (LOE), adverse events (AE) or others.ResultsA total of 117 patients were identified, 100% were switched to SB4 maintaining the same dose. Disease duration was 5 (2–8,5) years. 49 patients (41%) had basal optimized dose of ETN (dose down-titration or dose interval expansion). In most patients ETN was the first biologic.31 patients (26%) stopped SB4 treatment during follow-up, mainly due to LOE (67%) or AE (25%), with median duration of SB4 3,5 months (1,9-5,9). Most AE that led to withdrawal were dermatological (injection-site reactions, skin rash). 11 patients switched back to ETN, 15 to others. Two patients died, both were APS (one sudden death and one aneurysmal subarachnoid hemorrhage). After switching to SB4, one stable patient with AS had recurrent acute anterior uveitis, and psoriasis worsening were noted in 2 patients with APS. 2 patients needed reinstatement of the full dose of biologic because of LOE. The clinical situation on ETN was stable in 23 of the 31 (74%) patients who stopped SB4 (no flares or changes in treatment in the last 6 months before switch). Table 1 summarizes baseline characteristics and treatment outcomes.ConclusionBiosimilar switch of SB4 was successful in over 74% of cases and was well tolerated.Most patients who stopped SB4 due to LOE had a clinical stable situation in this observational study. Some concerns regarding the safety profile and interchangeability have raised and further evidence on the efficacy of transitioning from reference ETN is needed.References[1] Kay J, Schoels MM, Dörner T, et al. Ann Rheum Dis2018;77:165-174[2] Emery P, Vencovsky J, Sylwestrzak A, et al. Ann Rheum Dis2017;76:51–57[3] Glintborg B, et al. Ann Rheum Dis2019Feb;78(2):192-200Table 1 RA (n=47) APS (n=29) AS (n=30) JIA (n=8) Age (years)62 (53-71)51 (46-60)49 (42-60)42 (30-51)Female, n (%)33 (70,2%)11 (37,9%)4 (13,3%)2 (25%)Monotherapy, n (%)17 (36%)16 (55%)30 (100%)6 (75%)Dose optimization, n (%)18 (38,6%)13 (44,8%)12 (40%)5 (62,5%)Duration of ETN (years, median IQR)4 (1,8-6)4,2 (2-6)5,9 (2-10,6)6 (4,1-8,2)Other biologic drug prior to ETN, n ...

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