NEW YORK (Reuters Health)—After starting biologic therapy for rheumatoid arthritis (RA), patients with higher disease activity at baseline achieved greater improvements in measures of disease activity than those with lower levels of disease, but they were less likely to achieve remission or even low disease activity, according to a new real world analysis of registry data.
“These results raise the possibility that there might be a greater likelihood of achieving aggressive treatment targets, such as LDA [low disease activity] or remission, if biologic therapy is initiated before patients reach higher levels of disease activity,” Dr. Arthur Kavanaugh of the University of California, San Diego, and colleagues write in their report, published online on March 8 in Rheumatology.¹
In clinical trials, baseline disease activity is correlated with disease activity after initiation of disease-modifying anti-rheumatic drugs (DMARDs), but real world data on patients who start treatment at different levels of disease activity is limited, the researchers note.
To investigate, they looked at registry data on patients with moderate disease activity (Clinical Disease Activity Index score greater than 10, but no higher than 22) or severe disease activity (CDAI above 22).
At least one year of follow-up data was available on 1,596 patients, and 1,269 had at least two years of follow-up. Each group contained a roughly equal amount of moderate and severe RA patients.
At one year, improvement in disease activity was -18.9 in patients with severe RA and -6.0 in patients with moderate RA. At two years, improvement was -21.0 and -7.1, respectively.
Among patients with moderate disease, 22.7% achieved remission (CDAI of 2.8 or less) at one year, compared with 15.8% of those with severe RA. At two years, 25.9% and 20.9% were in remission, respectively.
LDA or remission were achieved at one year by 60.1% of patients with moderate disease and 41.2% of those with severe disease, and at two years by 66.7% and 49.4%, respectively.
At one year, more than 70% of patients were on the same drug, while more than 62% were on the same drug at two years.
“These data suggest that patients and physicians may be willing to accept treatment responses that are perceived as successful, even if they have not achieved the target of LDA,” the researchers write. “Therefore, modification of T2T (target to treat) goals may be warranted for some RA patients, for example, those with high disease activity and/or long-standing RA.”
Dr. Kavanaugh was not available for an interview request by press time.
Reference
- Kavanaugh A, Keystone E, Greenberg JD, et al. Benefit of biologics initiation in moderate versus severe rheumatoid arthritis: Evidence from a United States registry. Rheumatology (Oxford). 2017 Mar 8. doi: /10.1093/rheumatology/kex042.
