At least 6% of patients with rheumatoid arthritis (RA) who have used biologic disease-modifying antirheumatic drugs (bDMARDs) in their lifetimes experience bDMARD refractory disease, according to a study recently published in the Annals of the Rheumatic Diseases.

This study included 13,502 individuals with RA who were initiating a first-line tumor necrosis factor inhibitor. Of these, 867 (6%) were bDMARD refractory, defined as having initiated a third class of bDMARD. It took a median time of 8 years to initiate the third class of bDMARD. Multivariable analysis showed correlations between bDMARD refractory disease and patients who were more recently registered, were younger, had a shorter duration of disease, were women, showed higher patient global assessment, had a higher score on the Health Assessment Questionnaire, were current smokers, had more social deprivation, and were obese.

Data in this study were part of the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis, collected between 2001 and 2014. All follow-up was ceased no later than November 30, 2016. The study researchers examined reasons for stopping bDMARDs as well as switching patterns, and used Cox regression to gather baseline clinical characteristics that were related to refractory disease. Multiple imputation was used for missing baseline data.


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The study researchers conclude that “[this] first national study has identified the frequency of bDMARD refractory disease to be at least 6% of patients who have ever received bDMARDs. As the choice of bDMARDs increases, patients are cycling through bDMARDs quicker. The aetiopathogenesis of bDMARD refractory disease requires further investigation. Focusing resources, such as nursing support, on these patients may help them achieve more stable, controlled disease.”

Multiple researchers declare funding from pharmaceutical companies. See reference for a full list of disclosures and conflicts of interest.

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Reference

Kearsley-Fleet L, Davies R, De Cock D, et al; the BSRBR-RA Contributors Group. Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis [published online July 6, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213378