Registry Reveals That Many US Patients With RA Are Not Treated to Target

While guidelines recommend that patients with rheumatoid arthritis (RA) who do not have an adequate response to conventional disease-modifying antirheumatic drugs (DMARDs) be treated with biologics or Janus kinase (JAK) inhibitors, it remains common in clinical practice that patients remain in moderate or high disease activity without gaining access to more effective therapies.

Recently, researchers reported on the disease burden among patients with RA who did not advance to a biologic to treat their disease, and they found a considerable need for a treat-to-target approach.

The researchers used data from the Corrona RA registry, an independent, prospective, observational cohort of patients with RA that began in 2001. As of 2018, the registry included data from approximately 50,600 adult patients.

The research team used data for the 2982 biologic-naïve patients enrolled as of 2014 who had been taking conventional DMARDs for at least 6 moths. There were 414 patients who completed a follow-up visit at 3 to 9 months; 409 had Clinical Disease Activity Index (CDAI) assessments at 6 months.

Despite therapy with DMARDs for at least 6 months, 54% of patients with a CDAI assessment had persistent moderate to severe disease activity. These patients had higher baseline swollen and tender joint counts than patients who were in remission or who had low disease activity at 6 months.

Over the 6-month period, treatment advancement occurred for 29% of patients, and those who advanced to a new treatment were younger, had a shorter duration of RA, had higher disease activity, and reported higher levels of fatigue and pain than patients who did not advance to a new therapy.

These findings, write the authors, suggest “that potentially more aggressive treatment is needed across the entire population of patients with RA. Consistent with the findings in this study, patient factors, such as disease duration, disease activity, and work status, have been described elsewhere as contributing to patients receiving care in line with treatment recommendations.”

Future studies are needed, they add, to better examine factors related to the response variation to DMARDs and treatment selection for RA.

Reference

Harrold LR, Patel PA, Griffith J, et al. Assessing disease severity in bio-naïve patients with RA on treatment with csDMARDs: insights from the Corrona registry [published online October 21, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04727-7.