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Efficacy of Subsequent b/tsDMARD Use in Rheumatoid Arthritis

May 04, 2022 12:56 pm

Analysis of rheumatoid arthritis (RA) data from the British Society for Rheumatology Biologics Register shows that, even after failing three or more biologic or targeted synthetic DMARDs (b/tsDMARDs), patients may continue to benefit from repeated trials of unused b/tsDMARDs. 

BSRBR data from 2001 to 2020, and new new b/tsDMARD (excluding biosimilars) starts included 22 934 RA patients starting their first b/tsDMARD. Overall, 10 823 tried a second-line drug, 5,056 third, 2,128 fourth, 767 fifth and 292 sixth-line b/tsDMARDs. The outcomes included achieving DAS28 remission (≤2.6), low disease activity (LDA, ≤3.2) at 6 months, and median time to drug discontinuation

While TNF inhibitors were most frequently used first-line drug; the choice of subsequent therapies changed over time.

The odds of achieving remission or LDA decreased but plateaued with 2nd through 6th drug used.

  • DAS remission: 17% with first-line agents, then 13% second and 8% to13% with third through sixth b/tsDMARD choice
  • LDA: 29% with first-line, 23% second, 17–22% through to the sixth.
  • Duration of first-line therapy was a median of 2.6 years, but ranged from 1.0–1.4 years for lines two to six.

While the efficacy of repeated b/tsDMARD use over time does wane, it remains a viable efficacy option, even out to the 6th line choice. Research on better predictors of treatment selection is needed to avoid a "trial and error" to long-term RA management. 

Disclosures
The author has no conflicts of interest to disclose related to this subject

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