Zhao, Sizheng Steven 
ORCID: 0000-0002-3558-7353, Kearlsey-Fleet, Lianne, Bosworth, Ailsa, Watson, Kath and Hyrich, Kimme L
(2022)
Effectiveness of sequential biologic and targeted disease modifying anti-rheumatic drugs for rheumatoid arthritis.
RHEUMATOLOGY, 61 (12).
pp. 4678-4686.
Abstract
<h4>Objectives</h4>Whether patients with RA benefit from repeated trials of biologic or targeted synthetic DMARDs (b/tsDMARDs) after three or more attempts is unknown. We aimed to describe treatment outcomes in each line of b/tsDMARD therapy.<h4>Methods</h4>Using data from the British Society for Rheumatology Biologics Register for RA from 2001 to 2020, change to a new b/tsDMARD (except biosimilar switches) was defined as a new line of therapy. Treatment outcomes were compared across lines of therapy, including DAS28 remission (≤2.6), low disease activity (LDA, ≤3.2) at 6 months and median time to drug discontinuation. Multiple imputation was used for missing data.<h4>Results</h4>A total of 22 934 individuals starting a first b/tsDMARD were included (mean age 56 years, 76% female), among whom 10 823 commenced a second-line drug, 5056 third, 2128 fourth, 767 fifth and 292 sixth. Most (71%) had sufficient data for DAS28-derived outcome analyses. TNF inhibitors were the most common first-line drug, but choice of subsequent-line drugs changed over time. Seventeen percent achieved DAS28 remission following first-line, 13% second and 8-13% with third through sixth. LDA was achieved in 29% of first-line, 23% second, 17-22% through to the sixth. Patients stayed on first-line therapy for a median of 2.6 years, ranging from 1.0-1.4 years for lines two to six.<h4>Conclusion</h4>Many patients will eventually benefit after repeated trials of b/tsDMARD. Further research to improve treatment selection are needed to prevent prolonged trial and error approaches in some patients.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | biologics, difficult to treat, DMARDs, effectiveness, RA, switching |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 30 Jan 2024 11:15 |
| Last Modified: | 30 Jan 2024 11:40 |
| DOI: | 10.1093/rheumatology/keac190 |
| Open Access URL: | https://doi.org/10.1093/rheumatology/keac190 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3178134 |
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