Reasons for multiple biologic and targeted synthetic DMARD switching and characteristics of treatment refractory rheumatoid arthritis
Authors' conclusion
In a large EHR-based RA cohort, the most common reasons for b/tsDMARD switching were inadequate response, loss of efficacy, and nonallergic adverse events (e.g. infections, leukopenia, psoriasis). Clinical RA factors were insufficient for differentiating b/tsDMARD responders from nonresponders.
Study context
- Population
- RA patients prescribed ≥1 b/tsDMARD between 2001 and 2017 in a multi-hospital RA electronic health record (EHR) cohort404 meeting difficult to treat (D2T) criteria
- Participants
- 6,040 patients
- Exposure
- Treatment refractory RA vs b/tsDMARD initiators not meeting D2T criteria
- Outcome
- Reasons for b/tsDMARD switching (discontinuation) and characteristics associated with treatment refractory RA
Methodological detailsmulti-hospital, EHR cohort, manual chart review
- Multi-hospital
- EHR cohort
- Manual chart review
Main finding
As reported in the abstract
Reasons for medication discontinuation
Inadequate response
43.3 %
Loss of efficacy
25.8 %
Non-allergic adverse events
13.7 %
Observational data: associations, not effects.
Further findings
Age at b/tsDMARD initiation
P < 0.001
Female
P = 0.006
Ever smokers
P = 0.005
Treatment refractory RA among D2T RA
- Proportion of D2T RA with treatment refractory RA
- 15 %
RA clinical factors
- No RA clinical factors differentiated treatment refractory RA patients from b/tsDMARD initiators
Original publication
Reasons for multiple biologic and targeted synthetic DMARD switching and characteristics of treatment refractory rheumatoid arthritis. Semin Arthritis Rheum. Published 1 March 2024. doi:10.
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