Resistance to Treatment Escalation in Moderate or High Activity RA

Rheumatoid arthritis
Rheumatoid arthritis
Investigators observed that many patients with moderate or high rheumatoid arthritis activity are resistant to changing their treatment to achieve remission or low disease activity and sought to determine why.

A large proportion of patients with rheumatoid arthritis (RA) with moderate or high disease activity may fail to switch treatment to achieve remission or low disease activity, according to study results published in Arthritis Care & Research.

Researchers retrospectively studied 50,996 patients with RA, 27,274 of whom had longitudinal data available. They obtained clinical data from the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness registry between 2016 and 2017. Investigators defined index drug use as monotherapy with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or combination therapy with biologic DMARDs. The primary outcome measured was change in therapy over 12 months.

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After analysis, the researchers found that the frequency of treatment change over the follow-up period was fairly low (range, 35.6%-54.6%). In particular, patients receiving combination treatment with conventional synthetic DMARDs (adjusted odds ratio [aOR] 0.45; 95% CI, 0.33-0.61) or biologic DMARDs (aOR 0.3; 95% CI, 0.24-0.38), in addition to patients aged 75 years or older (aOR 0.63; 95% CI, 0.5-0.78) were less likely to switch therapy.

“One- to two-thirds of [patients with RA] failed to change their treatment, even when in moderate/high disease activity,” the researchers wrote.

One key limitation of the study was the retrospective design.

“Multi-modal interventions directed both at patients and providers are needed to encourage shared decision making, goal directed care, and to overcome barriers to treatment escalation,” the authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Yun H, Chen L, Xie F, et al. Do patients with moderate or high disease activity escalate RA therapy according to treat-to-target principles? Results from the ACR’s RISE Registry [published online September 30, 2019]. Arthritis Care Res. doi:10.1002/acr.24083