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- Title
Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset.
- Authors
Youssef, Peter; Marcal, Bruno; Button, Peter; Truman, Matt; Bird, Paul; Griffiths, Hedley; Roberts, Lynden; Tymms, Kathleen; Littlejohn, Geoff
- Abstract
<bold>Objective: </bold>To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi).<bold>Methods: </bold>This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation.<bold>Results: </bold>Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was "lack of efficacy" (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27-74).<bold>Conclusion: </bold>A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.
- Subjects
RHEUMATOID arthritis; ANTIRHEUMATIC agents; TUMOR necrosis factors; RITUXIMAB; PATIENTS
- Publication
Journal of Rheumatology, 2020, Vol 47, Issue 8, p1174
- ISSN
0315-162X
- Publication type
journal article
- DOI
10.3899/jrheum.190535