Can Early Biologics Prevent Difficult-to-Treat RA?

TOPLINE:

Early escalation to biologic therapies after failure of treat-to-target with methotrexate in patients with rheumatoid arthritis (RA) does not significantly reduce the risk for the development of difficult-to-treat RA.

METHODOLOGY:

• Researchers conducted a retrospective analysis including 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-up for at least 3 years after 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 reach the therapeutic target.
• Follow-up for patients who started b/tsDMARDs occurred every 2 months for the first 6 months, then every 4 months, with a target of achieving low disease activity (28-joint disease activity score,
• 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 dropped from 72.3% at 12 months to 41.6% at 60 months, indicating a decline in treatment persistence over time.
• Early escalation to biologic therapies did not significantly reduce the risk for difficult-to-treat RA, with 29% patients meeting the criteria after a median follow-up period of 72.6 months.
• Patients with higher disease activity and a higher 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 greater number of swollen joints, worse pain scores, and 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 & Therapy.

LIMITATIONS:

The escalation to b/tsDMARDs was not strictly guided by disease activity scores, potentially reflecting clinical practice. Additionally, the study did not account for socioeconomic factors or adherence, which may have influenced treatment outcomes.

DISCLOSURES:

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

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