Association between initial treatment strategy and progression to difficult-to-treat rheumatoid arthritis (difficult-to-treat RA (D2T-RA)): evidence from a 20-year-old real-world cohort
Authors' conclusion
In this observational cohort, initial MoA choice was not associated with D2T-RA progression.
Study context
- Population
- Patients with established rheumatoid arthritis (RA) followed from first consultation through all b/tsDMARD lines to last follow-up or D2T-RA classificationpost-2000 subcohort 498
- Participants
- 675 patients
- Exposure
- Initial b/tsDMARD choice: Tumour necrosis factor inhibitor (TNFi) vs non-TNFi starters; TNFi-cycling vs other mechanism of action (MoA)-switching strategies
- Outcome
- Progression to D2T-RA
Methodological detailsreal-world cohort, Kaplan-Meier, log-rank and multivariable Cox regression analyses
- Real-world cohort
- Kaplan-Meier, log-rank and multivariable Cox regression analyses
Main finding
As reported in the abstract
D2T-RA criteria fulfilled (whole cohort)
126
18.7%
Observational data: associations, not effects.
Further findings
Factors associated with D2T-RA (multivariable Cox)
- GC exposure, increased risk: HR
- 2.47 (1.38 to 4.42) (95% CI)
- Delayed b/tsDMARD initiation, decreased hazard: HR
- 0.990 (0.98 to 0.996) (95% CI)
TNFi share of treatment lines
- First-line treatments
- 81.0%
- Second-line treatments
- 53.2%
Original publication
Association between initial treatment strategy and progression to difficult-to-treat rheumatoid arthritis (D2T-RA): evidence from a 20-year-old real-world cohort. RMD Open. Published 23 September 2026. doi:10.
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