Tumor necrosis factor inhibitors (TNFis) have comparable effectiveness to non-TNFis in the treatment of rheumatoid arthritis (RA), according to study data published in Annals of the Rheumatic Diseases.

Investigators extracted data from the Consortium of Rheumatology Researchers of North America RA Registry, a large healthcare database of patients with RA in the United States. Adult patients with clinician-diagnosed RA and a Clinical Disease Activity Index (CDAI) >2.8 were eligible for inclusion in the study. Patients who were initiated with a first-line TNFi or non-TNFi between 2001 and 2018 were enrolled. Patients with prior exposure to a biologic or targeted synthetic DMARD were excluded from the study. Baseline clinical and demographic characteristics were collected before treatment initiation. The primary outcome was change in CDAI at 1 year after initiation of TNFi or non-TNFi. Low disease activity was defined as CDAI ≤10; remission was defined as CDAI ≤2.8. Secondary end points included various patient-reported outcomes, such as quality of life, quality of sleep, fatigue, and morning stiffness. Groups were propensity score-matched at baseline. Random effect regression models were used to compare outcome measures between the TNFi and non-TNFi treatment groups.

The study cohort included 4816 individuals, among whom 4186 were with initiated a TNFi and 630 with a non-TNFi. The mean age of patients in the TNFi and non-TNFi groups were 56.9±12.7 years and 62.7±13.0 years, respectively. A majority of the TNFi and non-TNFi groups were women (76.5% and 79.8%, respectively).

Overall, both groups had significant improvements in RA symptoms and patient-reported quality of life. At 1 year, similar proportions of the TNFi and non-TNFi groups achieved low disease activity (39.9% and 41.6%, respectively; P =.87) and remission (17.6% vs 16.3%; P =.26). Both groups also had comparable improvements in mean changes in CDAI (P =.16), Health Assessment Questionnaire scores (P =.07), and patient-reported morning stiffness (P =.29) and fatigue (P =.42). After propensity matching, the TNFi vs non-TNFi groups had lower incidence of anemia (19.04 vs 24.01 cases per 100 person-years, respectively; P =.03). However, the 2 groups did not significantly differ on other outcomes.

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Results indicated that both TNFi and non-TNFi treatment may be appropriate after the failure to respond to csDMARDs.

“The findings of no significant differences in outcomes between first-line TNF and first-line non-TNF groups support RA guidelines which recommend [individualized] care based on clinical judgement and consideration of patient preferences,” the investigators concluded.

Disclosures: This study was supported by Corrona, LLC, and the analysis was supported by Regeneron Pharmaceuticals, Inc, and Sanofi.


Pappas DA, St John G, Etzel CJ, et al. Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study. Ann Rheum Dis. Published online July 21, 2020. doi:10.1136/annrheumdis-2020-217209