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Number of Prior DMARDs Portends Poorer Outcomes

Detailed analysis of two clinical trials in rheumatoid arthritis (RA) has shown that clinical responses decrease as the disease duration and number of prior disease-modifying antirheumatic drugs (DMARDs) increase.

The associations between disease duration and number of prior DMARDs and response to therapy were assessed using data from two randomised controlled trials in patients with established RA (mean duration, 11 years) receiving adalimumab+methotrexate.

Clinical efficacy responses were assessed at week 24 using standard disease activity outcomes.

Both trials demonstrated that a greater number of prior DMARDs and longer RA duration were associated with lower ACR response rates at week 24.

In one trial of 207 RA patients showed when comparing a many to few prior DMARDs (>2 vs 0–1) there was smaller improvements by week 24 in:

  • DAS28(CRP) (–1.8 vs –2.2)
  • SDAI (–22.1 vs –26.9)
  • HAQ-DI (–0.43 vs –0.64)\.

When comparing disease duration (>10 years versus <1 year) higher HAQ-DI scores (1.1 vs 0.7) were seen at week 24, but results on DAS28(CRP) and SDAI were mixed.

Number of prior DMARDs, moreso than disease duration, appears to identify refractory RA patients who may not respond as well to future treatment interventions.

The author has received compensation as an advisor or consultant on this subject

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