Concomitant csDMARD Use Linked to Reduced Risk for bDMARD Discontinuation in RA

Researchers examined the effect of concomitant csDMARD use on time to bDMARD discontinuation in patients with rheumatoid arthritis.

The concurrent use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) was associated with significantly reduced rates of bDMARD cessation in patients with rheumatoid arthritis (RA), according to study results published in The Journal of Rheumatology.

Researchers retrospectively analyzed clinical data from the Ontario Best Practices Research Initiative (OBRI) in Ontario, Canada. The cohort included 814 patients with RA who were treated with either bDMARD monotherapy or concomitant csDMARD and bDMARD therapy. The effects of concurrent use were assessed as the primary outcome, and the effects of the methotrexate route of administration on bDMARD durability was also evaluated as a secondary outcome.

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After analysis, the researchers found a nonsignificant trend towards reduced discontinuation in patients treated with csDMARD and bDMARD combination therapy vs bDMARD monotherapy for any reason (hazard ratio [HR], 0.76; 95% CI, 0.55-1.05) and due to ineffectiveness or adverse events (HR, 0.73; 95% CI, 0.50-1.06). In addition, they reported that patients receiving combination therapy had a significantly reduced likelihood of bDMARD discontinuation owing to adverse events (HR, 0.43; 95% CI, 0.24-0.76).

No statistical links between the methotrexate route of administration and bDMARD discontinuation were observed.

One key limitation of the study was its small sample size.

“Overall, these results support the use of bDMARD in combination with csDMARD among patients with active RA, and suggest that either oral or subcutaneous methotrexate is appropriate when used in combination with a bDMARD,” the researchers wrote.


Lau AN, Thorne JC, Movahedi M, et al. Effect of concomitant disease-modifying antirheumatic drugs and methotrexate administration route on biologic treatment durability in rheumatoid arthritis: OBRI cohort results [published online April 15, 2019]. J Rheumatol. doi:10.3899/jrheum.180486