Rheumatoid arthritis
(RA) is a chronic systemic autoimmune inflammatory disease that causes severe
progressive joint damage, functional disability, thereby affecting the overall health-related
quality of life.
Only 56.8% of rheumatoid arthritis (RA) patients continued second
biological disease-modifying anti-rheumatic drug (bDMARD) treatment after 12
months (60% if re-start was included). Non-anti-TNF patients had a higher
probability of continuing second bDMARD therapy.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that causes severe progressive joint damage, functional disability, thereby affecting the overall health-related quality of life. The current treatment guidelines recommend the use of methotrexate (MTX), a synthetic disease-modifying anti-rheumatic drug (sDMARD), in combination with glucocorticoids in newly diagnosed RA patients. If MTX therapy fails to reach the treatment goal, it is recommended to switch to another sDMARD (e.g., sulfasalazine, leflunomide, hydroxychloroquine) or to add a biological DMARD (bDMARD) to MTX therapy. The bDMARDs are distinguished into two broad classes (based on the mechanism of action), anti-TNFs (e.g., Infliximab, Etanercept, Adalimumab, Golumumab, Certolizumab) and non-anti TNFs (e.g., Abatacept, Anakinra, Tocilizumab, Rituximab). According to evidences, the first line DMARDs are usually discontinued after a period of 12 months due to loss of efficacy of the drugs over time and their intolerable side effects. This discontinuation leads to treatment failure and various side effects. It is always a matter of debate whether after using an anti-TNF therapy, treatment with a second-line anti-TNF or treatment with a non-anti-TNF biological is a strategy that maximizes drug survival of a second bDMARD therapy. Therefore, this study was conducted to assess drug survival of a second bDMARD therapy in RA patients hypothesizing that there is a difference in drug survival between a second anti-TNF versus non-anti-TNF therapy.
Rationale behind the research:
Objective:
To evaluate the discontinuation-, re-initiation- or continuation-rates of a second bDMARD therapy as well as switching-rates to a third bDMARD therapy in RA patients.
Study outcome measures:
Time Points: At baseline and 12-month
Study outcomes
Baseline: There were no significant differences in baseline characteristics between the groups.
The results of this
study indicated that substantial
number of RA patients discontinued or switched their second bDMARD therapy
within 12 months. This was the first study to analyse drug survival of a second
bDMARD therapy in RA patients. The study also showed that discontinuation of a
bDMARD therapy does not always leads to therapy failure or serious adverse
events. The reasons for switching of therapy were not clearly understood in
this study, but according to previous studies the discontinuation of current
therapies were due to lack of disease remission and side effects.
Patients on non-anti TNF bDMARDs as second bDMARD therapy have a lower probability to discontinue their treatment. Thus, this study allows a better understanding and interpretation of drug survival observed in clinical practice settings.
BMC Musculoskeletal Disorders (2017) 18:332
Drug survival of second biological DMARD therapy in patients with rheumatoid arthritis: a retrospective non-interventional cohort analysis
Wilke et al.
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