Press Release. The key findings from the research were:

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1 Press Release Sanofi and NRAS launch RefRAme the Future campaign to highlight the importance of mental strength in helping people with rheumatoid arthritis (RA) better manage their condition New campaign aims to empower people living with RA to take action to live a better life with this long-term condition Mental resilience is critical in RA, given that 38% of people with the condition can experience depression 1, and the pain caused by the physical damage of the disease can be intensified by anxiety 2 Drawing on real-life insights from people living with RA, Sanofi has developed online tools to assist patients to cope with the emotional impact of this chronic condition Guildford, UK March 21, 2018 Working in partnership with the National Rheumatoid Arthritis Society (NRAS), Sanofi and its specialty care global business unit, Sanofi Genzyme, today launches RefRAme the Future, a campaign that highlights the importance of building mental resilience to help people better cope with the day-to-day challenges of rheumatoid arthritis (RA). To further explore the existing link between RA and mental health, Sanofi commissioned a piece of behavioural research with 10 people between the ages of living with RA. 3 The insights we uncovered demonstrate that RA can have a negative impact on emotional wellbeing across many aspects of a person s life, particularly when there is a perceived lack of control, explains Philip Graves, Consumer Behaviour Consultant who carried out the research. It is important that people with RA have the right tools to help them take control of their RA every day and don t just accept negative feelings - we need to encourage them to feel empowered to go back to their doctor and live their lives to the fullest. The key findings from the research were: For people with RA, a number of factors can contribute to stress, anxiety and potential depression. These are closely linked with the age and, particularly, life stage of the patient. In particular, stress levels are highest for a person prior to being diagnosed, and also when the condition is not well managed. After a RA diagnosis, men and women have different psychological worries about the disease. For men, RA can make them feel less physically strong, which affects their

2 self-esteem and makes them feel less attractive to a potential partner. It was noted that women, on the other hand, have concerns about the impact of RA on starting a family and their ability to be a good parent. Workplace bullying and discrimination can occur, which can have a negative impact on mental health and wellbeing. For example, working in an unsupportive environment, where co-workers can become resentful of perceived time off due to sick leave, was a source of anxiety for people with RA. People with RA are generally focused on day-to-day life, particularly when their condition is well-managed and are not actively thinking about how to look after their future health. 3 In line with existing evidence pointing to the importance of mental resilience for those dealing with long-term chronic conditions, the insights gathered from these interviews with people with RA further highlight the need for greater attention to be paid to this issue. Sanofi and NRAS hope to raise the importance of mental resilience of those with RA through this new campaign and encourage people to make small everyday changes that may help improve their mind-set. The RefRAme the Future website provides resources designed to empower people with RA to make the changes today that may positively impact their future physical and mental health and wellbeing. These tools include guided mindfulness exercises that anyone can practice. Studies have shown that addressing the psychological support needs of a person with RA through building mental resilience can help prevent the onset of mental health problems such as depression, said Ailsa Bosworth, National Rheumatoid Arthritis Society (NRAS), CEO. It is important to highlight the emotional issues associated with RA, something I am well aware of since my own diagnosis. In an NRAS study conducted in 2013, 84% of people with RA stated that the emotional impact of the disease was as significant as the physical impact 4. It is crucial to support people holistically considering all their needs. Living with a long term incurable disease like RA requires far more than just medications that s why empowering individuals to accept their disease and take control of their lives with the condition is so important. More than 400,000 people in the UK live with RA, 5 and the physical impact that symptoms of pain, swelling, stiffness, or fatigue 6 can have on daily life are often underestimated. While RA is typically thought of as a physical disease of the joints, its impact unfortunately extends beyond bones and cartilage. 7 RA is an unforgiving, long-term condition while often invisible, its issues are not just physical, added Dr Mohini Gray, Reader in Rheumatology and Honorary Consultant Rheumatologist, University of Edinburgh and Western General Hospital, Edinburgh. The emotional impact on a person s daily life can be a huge burden. As physicians, it is crucial that we are addressing all of the patient s needs, both physically and emotionally. Learning to look at things differently can help improve our lives today. Learn about how changing our mind-set, can help reframe our lives tomorrow.

3 About RefRAme the Future The RefRAme the Future campaign is about taking control of RA and shaping a better future. To find out more information, learn how you can build mental resilience to help better manage living with this chronic and painful condition and to explore the mindfulness exercises available visit About rheumatoid arthritis (RA) RA is both progressive and chronic as well as systemic. It is caused by a malfunction of the immune system. People with RA can suffer from severe pain, swelling, stiffness, or fatigue as the immune system attacks the tissues of the joints, causing inflammation and destroying bone and cartilage. 6 Internal organs can also be affected including the heart, eyes and lungs. 8 The impact that these symptoms and complications have on daily life is often underestimated. RA can affect people of any age but is most common in people aged between years 9 with 75% of patients diagnosed while of working age. 10 Up to 40% of people with RA will have stopped working within five years of being diagnosed. 11 ### About National Rheumatoid Arthritis Society (NRAS) NRAS is the only patient led organisation in the UK focusing specifically on rheumatoid arthritis and juvenile idiopathic arthritis (JIA). NRAS provides information, support, advocacy and campaigns on behalf of people with RA and JIA, their families and their health professionals. Changing Minds, Changing Services and Changing Lives is the mission of the charity. For more information visit or call or enquiries@nras.org.uk/. About Sanofi Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We prevent illness with vaccines, provide innovative treatments to fight pain and ease suffering. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions. With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation into

4 healthcare solutions around the globe. Sanofi, Empowering Life Sanofi Genzyme focuses on developing specialty treatments for debilitating diseases that are often difficult to diagnose and treat, providing hope to patients and their families. Learn more at Media Relations Contact Stefanie Holman Sanofi UK & Ireland Tel.: or Emma Coughlan Edelman Tel.: or References 1 Matcham F, Rayner L, Steer S et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013;52: Matcham F, Norton S, Scott, DL et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology. 2016;55: Sanofi data on file, March NRAS Survey 2013: Relationships, emotions, sexuality. Available at: d%20sexuality%20-%20report%20april% pdf 5 Arthritis Research UK. State of musculoskeletal health Available at: 6 Rheumatoid Arthritis. What is rheumatoid arthritis? Available at: 7 Arthritis Foundation. The arthritis-depression connection. Available at: (Accessed March 2018). 8 NHS Choices UK. Rheumatoid arthritis. Available at: (Accessed March 2018) 9 British Society of Immunology. Rheumatoid arthritis. Available at: 10 National Rheumatoid Arthritis Society. Right answer? Key questions for my new MP. Available at: df 11 Young A, Dixey J, Kulinskaya E et al. Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS). Ann Rheum Dis. 2002;61:335-40

5 SAGB.IMM Date of Preparation: March 2018