First-line targeted therapy may be effective than traditional approach in RA patients

The use of first-line targeted therapy (TT) in initial 6 months can be effective in reaching remission (REM) or low disease activity (LDA) at 12 months in RA patients, according to the findings of a prospective observational cohort study published in ‘Arthritis Research & Therapy’ Journal.

In RA patients, the treat-to-target (T2T) aims to achieve a goal of a minimum LDA within 6 months; or else, the existing therapy should be altered. This study under consideration assessed if changing a first-line TT in patients not attaining LDA in 6 months’ gives way to a greater likelihood of attaining the same at 12-months’.

Patients with RA starting the first-line TT and with a minimum of 1-year follow-up were included. Four mutually exclusive patient groups were made as per (1) changing to another TT within the starting year and getting a treatment target (DAS28-ESR ≤ 3.2) at 6 months. A comparison of odds for REM or LDA at the 12 months follow-up between patients changing and not changing TT after not attaining treatment target at 6 months was regarded as the primary outcome. The propensity score was used to match patients at the 6 months.

All in all, 1275 patients were suitable for the analysis. Details of patients in the four patient groups (cohorts) has been described in the following table:

Seventy-five patients each were matched from cohort C3 and C4 by means of the propensity score. As compared to patients not committed to the T2T strategy (C4), the patients adhering to this strategy (C3) had a 2.8 times increased probability of attaining REM/LDA at the 12 months follow-up.

In conclusion, the T2T strategy is underutilized in the daily clinical practice, requiring further consideration in future practices.