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This study validated the
current practice of using bDMARDs and csDMARDs combination in rheumatoid
arthritis and suggest the use of etanercept as first-line anti-TNF monotherapy
for the same.
According to the researchers of University of Ferrara and Italian Society for Rheumatology (SIR) Italy, the combination of bDMARDs and csDMARDs is efficacious in RA treatment. Concomitant use of methotrexate, leflunomide and csDMARDs in combination is also associated with longer survival on bDMARD.
The Ettore Silvagni and colleagues conducted a retrospective
observational study by considering Administrative Healthcare Databases. The RA
patients who began first-line recommended the course of bDMARDs were included.
Cox proportional hazard models were employed to measure drug survival among
these patients. HRs and 95% CI along with crude and adjusted for prespecified
confounders used to present the result of the analysis. Prespecified
confounders used in this study were sex, disease duration, age, previous
infections, use of concomitant glucocorticoids or non-steroidal
anti-inflammatory drugs (NSAIDs), and Charlson Comorbidity Index (CCI).
A total of 4478 RA patients were involved with 17.84%
monotherapy rate. The first line biologics for the management were Etanercept,
Infliximab, and Adalimumab. Higher CCI, lower NSAIDs & glucocorticoids use,
and longer disease duration was noticed during the bDMARD monotherapy while
combined treatment reflected reduced failure risk. Acknowledging Etanercept as
a reference, Infliximab and Adalimumab exhibited higher failure risk and lower
retention rate among the monotherapies. However, in the combination therapy,
csDMARD, leflunomide, or methotrexate combinations lowers the risk of bDMARD withdrawal.
As per the findings, csDMARD and bDMARD combination proven to be significant
combination therapy for rheumatoid arthritis treatment.
BMJ Open
Comparative effectiveness of first-line biological monotherapy use in rheumatoid arthritis: a retrospective analysis of the RECord-linkage On Rheumatic Diseases study on health care administrative databases.
Ettore Silvagni et al.
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