Can early biologics prevent hard-to-treat RA?

On By Pranco

TOP LINE:

Early escalation to biologic therapies after treatment-to-target failure with methotrexate in patients with rheumatoid arthritis (RA) does not significantly reduce the risk of developing refractory RA.

METHODOLOGY:

  • Researchers conducted a retrospective analysis of 722 patients with new-onset RA (mean age 60 years; 72% women) who were identified from a cohort at the IRCCS Policlinico San Matteo University Hospital in Italy and followed for at least 3 years thereafter. diagnosis.
  • Patients were initially treated with methotrexate, with escalation to biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in case they did not achieve the therapeutic goal.
  • Follow-up for patients initiating b/tsDMARDs occurred every 2 months for the first 6 months, then every 4 months thereafter, with the goal of achieving low disease activity (28-joint disease activity score, <3.2).
  • The effectiveness of each DMARD was evaluated using drug survival rates, and the development of difficult-to-treat RA was assessed using the European Alliance of Associations for Rheumatology criteria.

TAKEAWAY:

  • The retention rate of the first b/tsDMARD decreased from 72.3% at 12 months to 41.6% at 60 months, indicating a decrease in treatment persistence over time.
  • Early escalation to biologic therapies did not significantly reduce the risk of refractory RA; 29% of patients met criteria after a median follow-up period of 72.6 months.
  • Patients with higher disease activity and a greater number of swollen joints at the start of biologic therapy were more likely to develop treatment resistance.
  • Shorter disease duration at the start of treatment with b/tsDMARDs, a higher number of swollen joints, worse pain scores and an autoantibody-negative status were identified as independent predictors of difficult-to-treat RA.

IN PRACTICE:

“Early implementation of treatment after failure of treat-to-target with MTX (methotrexate) may not prevent the development of D2T (difficult to treat) in patients with RA,” the authors concluded.

SOURCE:

The study was led by Bernardo D’Onofrio, MD, and Ludovico De Stefano, MD, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy. It was published online on November 8, 2024, in Arthritis research and therapy.

LIMITS:

Escalation to b/tsDMARDs was not strictly guided by disease activity scores, which may have reflected clinical practice. Additionally, the study did not take into account socioeconomic factors or treatment adherence, which may have influenced treatment outcomes.

DISCLOSURE:

This study was supported by a grant from the IRCCS Policlinico San Matteo Foundation. One author reported receiving grants/research support and personal compensation, and two authors reported receiving personal compensation from various pharmaceutical companies.

This article was created using various editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.