Treatment sequences and lines of therapy in rheumatoid arthritis: a real-world evaluation of retention and effectiveness
Authors' conclusion
First-line AT is associated with superior survival and effectiveness; however, subsequent therapies continue to provide important clinical benefits.
Study context
- Population
- Adult rheumatoid arthritis (RA) patients from the Ontario Best Practice Research Initiative (OBRI) who initiated advanced therapy between 2008 and 2023
- Participants
- 2,449 patients
- Exposure
- Successive lines of advanced therapy; initiation before vs after 2010
- Outcome
- Drug survival (time from initiation to discontinuation) and effectiveness (change in CDAI; MCID, LDA, remission) across lines of therapy
- Follow-up
- 6 months (effectiveness)
Methodological detailsreal-world, propensity-score adjusted, multiple imputation for missing data
- Real-world
- Propensity-score adjusted
- Multiple imputation for missing data
Main finding
As reported in the abstract
Drug survival (treatment duration)
Observational data: associations, not effects.
Further findings
Effectiveness by line of therapy (Clinical Disease Activity Index (CDAI) improvement, minimal clinically important difference (MCID), low disease activity (LDA), remission) · 6 months
- First-line therapies showed greater CDAI improvement and higher MCID, LDA and remission rates
- Effectiveness declined in later lines but remained clinically meaningful
Original publication
Treatment sequences and lines of therapy in rheumatoid arthritis: a real-world evaluation of retention and effectiveness. Clin Exp Rheumatol. Published 23 June 2025. doi:10.
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