Do Biologics Decrease the Need for Mechanical Aids in RA?

Researchers have found that with widespread use of biologics in the “mature biologics era” from 2010-2012, patients with rheumatoid arthritis (RA) had significantly lower use of mechanical aids and devices compared with less frequent use of biologics in the “emerging biologics era” from 2001-2003.

In patients with RA, “disability can lead to dependence on mechanical aids and/or assistants for performance of activities of daily living, which may contribute to work disability and decreased health-related quality of life (HRQOL),” wrote Vibeke Strand, MD, from the Division of Immunology and Rheumatology at the Stanford University School of Medicine in Palo Alto, California and colleagues. These mechanical aids commonly used by RA patients can include devices used for opening jars/bottles, as well as for reaching, sitting, standing, and walking.

From approximately 1999 to 2006, 3 biologic disease-modifying antirheumatic drugs (DMARDs) were approved for treating RA in the United States, with the proportion of patients who had ever used a biologic having increased from approximately 3% to 27–33%. Major use of biologic agents began after 2005. Currently, 9 biologic agents are approved to treat RA in the US.

Before this study was conducted it was unclear whether the introduction of more biologic agents, accompanied by their increased use over time, was associated with less general dependence on mechanical devices or less dependence of specific types of mechanical aids. 

“The aims of this study were to investigate change in use of mechanical devices/aids by RA patients since the introduction of biologic DMARDs, and to examine potential predictors of mechanical devices/aids use among patients with RA,” the authors wrote.

Using the Consortium of Rheumatology Researchers of North America (CORRONA), an observational cohort and the largest RA registry in North America to date, the researchers analyzed 1096 patients with RA with an average age of 60.0 ± 13.6 years from the 2001-2003 period, and 11,140 patients with RA with an average age of 60.7 ± 12.6 years from the 2010-2012 period. A majority of patients in both cohorts were women (69.4% and 76.0%), white (90.7% and 89.7%), married (68.5% and 66.6%), and not working (58.4% and 54.5%).

The researchers found that fewer patients used mechanical devices/aids for performance of everyday physical activities in the mature biologic agents era (2010–2012) compared with the emerging biologic agents era (2001–2003). Disease related outcomes also improved in patients in the mature biologic agents era compared with those in the emerging biologic agents era.

“The overall decrease in dependence on mechanical aids is generally consistent with results from previous studies that have shown better outcomes in patients with RA since the introduction of biologic DMARDs, including decreased disease activity and less radiographic progression, and decreased functional impairment, work disability, hospitalizations, and surgeries,” the authors wrote.

Summary & Clinical Applicability

Biologic-experienced patients with RA used mechanical assistive devices at lower frequencies during 2010–2012 as compared to biologic-naive patients, suggesting that biologic use was associated with reduced disability.

“These results indicate that improvement in the standard of care for patients with RA is associated with improved outcomes in the mature biologic agents era,” the authors wrote.

They also noted that the mechanical aid use was still significant in those patients from the mature biologic era, at a rate of 30%. This suggests that further improvement in preventing disability is still possible. Further studies are needed to confirm these results and to define the role that biologics have in decreasing long-term disability in patients with RA. 

Limitations & Disclosures

• The CORRONA registry does not specifically assess the possession and use of assistive devices, so the use of these devices could only be determined from the Health Assessment Questionnaire disability index (HAQ DI)
• Patients may adapt to assistive devices and may therefore underestimate their use on self reports
• Patient selection may have changed over time
• Data from the CORRONA registry is limited to those collected at office visits so remaining confounding factors may have remained unidentified.

Reference

Strand V, Greenberg JD, Griffith J, et al. Impact of treatment with biologic agents on the use of mechanical devices among rheumatoid arthritis patients in a large US patient registry. Arthritis Care Res (Hoboken). 2016;68(7):914-21.