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. 2018 Oct;77(10):1405-1412.
doi: 10.1136/annrheumdis-2018-213378. Epub 2018 Jul 6.

Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Lianne Kearsley-Fleet  1 , Rebecca Davies  1 , Diederik De Cock  1 , Kath D Watson  1 , Mark Lunt  1 , Maya H Buch  2   3 , John D Isaacs  4 , Kimme L Hyrich  1   5 ; BSRBR-RA Contributors Group
Affiliations

Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Lianne Kearsley-Fleet et al. Ann Rheum Dis. 2018 Oct.

Abstract

Objectives: Biologic disease-modifying antirheumatic drugs (bDMARDs) have revolutionised treatment and outcomes for rheumatoid arthritis (RA). The expanding repertoire allows the option of switching bDMARD if current treatment is not effective. For some patients, even after switching, disease control remains elusive. This analysis aims to quantify the frequency of, and identify factors associated with, bDMARD refractory disease.

Methods: Patients with RA starting first-line tumour necrosis factor inhibitor in the British Society for Rheumatology Biologics Register for RA from 2001 to 2014 were included. We defined patients as bDMARD refractory on the date they started their third class of bDMARD. Follow-up was censored at last follow-up date, 30 November 2016, or death, whichever came first. Switching patterns and stop reasons of bDMARDs were investigated. Cox regression identified baseline clinical factors associated with refractory disease. Multiple imputation of missing baseline data was used.

Results: 867 of 13 502 (6%) patients were bDMARD refractory; median time to third bDMARD class of 8 years. In the multivariable analysis, baseline factors associated with bDMARD refractory disease included patients registered more recently, women, younger age, shorter disease duration, higher patient global assessment, higher Health Assessment Questionnaire score, current smokers, obesity and greater social deprivation.

Conclusions: This first national study has identified the frequency of bDMARD refractory disease to be at least 6% of patients who have ever received bDMARDs. As the choice of bDMARDs increases, patients are cycling through bDMARDs quicker. The aetiopathogenesis of bDMARD refractory disease requires further investigation. Focusing resources, such as nursing support, on these patients may help them achieve more stable, controlled disease.

Keywords: dmards (biologic); epidemiology; rheumatoid arthritis.

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Conflict of interest statement

Competing interests: MHB has received grants from Pfizer Ltd and Roche Pharmaceuticals, as well as expert advice and honoraria from Abbvie, Astra-Zeneca, BMS, Lilly, Roche, Sandoz and UCB. JDI has received research grants from Pfizer Ltd and Roche Pharmaceuticals, as well as honoraria/fees from Abbvie, Roche, Pfizer, Janssen and BMS.

Figures

Figure 1
Figure 1
Cumulative incidence plot (95% CIs) of when patients acquire biologic disease-modifying antirheumatic drug (bDMARD) refractory disease (point of starting their third class of bDMARD) (n=13 502). Stratified by recruitment year: prior to 2001–2008 (solid line; n=11 654) and 2011–2014 (dashed line; n=1848).
Figure 2
Figure 2
Main pattern of biologic disease-modifying antirheumatic drug (bDMARD) class switching in the 867 bDMARD refractory patients.
See this image and copyright information in PMC

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