More RA Treatment Options Needed for Patients With Inadequate Response to MTX, bDMARDs

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There is an unmet treatment need for patients with RA who have an inadequate response to MTX or bDMARD therapy.

There is an unmet treatment need for patients with rheumatoid arthritis (RA) who have an inadequate response to methotrexate (MTX) monotherapy, biologic disease-modifying antirheumatic drug (bDMARD) monotherapy, or bDMARD treatment in combination with MTX or other conventional synthetic DMARDs (csDMARDs) after 12 months, according to results published in Rheumatology.

The study included participants receiving MTX monotherapy, bDMARD monotherapy, bDMARDs plus MTX, or bDMARDs plus other csDMARDs from January 2007 to July 2016. The researchers used the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-4[ESR]) to measure remission (score, <2.6) and inadequate response (score, >3.2) at 6 and 12 months of treatment.

Of a total of 2778 participants, 714 were treated with MTX monotherapy, 396 with bDMARD monotherapy, 1460 with bDMARD plus MTX, and 208 with bDMARDs plus other csDMARDs.

Of the participants who had DAS28-4(ESR) data at 6 and 12 months, 33.9% to 47.2% did not switch treatment and had inadequate response at 12 months. The researchers did not find any significant differences in efficacy between treatment groups.

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The most common reason for discontinuing treatment across all treatment groups was lack of efficacy (13.7% to 22.1% over the course of 24 months).

“Although there are many differing treatment strategies available to patients with moderate to severe RA, there exists a substantial unmet treatment need for patients who still experience [inadequate response] to MTX and bDMARDs, without clinical remission, after up to 12 months of treatment,” the researchers wrote.

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Olsen IC, Lie E, Vasilescu R, et al. Assessments of the unmet need in the management of patients with rheumatoid arthritis: analyses from the NOR-DMARD registry [published online November 30, 2018]. Rheumatology. doi: 10.1093/rheumatology/key338