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. 2024 Mar 1;63(3):648-656.
doi: 10.1093/rheumatology/kead261.

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

Sizheng Steven Zhao  1 , Kira Rogers  2 , Lianne Kearsley-Fleet  1 , Kath Watson  1 , Ailsa Bosworth  3 , James Galloway  4 , Suzanne Verstappen  1 , Darren Plant  5 ; BSRBR-RA Contributors Group, BRAGGSS Collaborators; Anne Barton  5   6 , Kimme L Hyrich  1   6 , Jenny H Humphreys  1   6
Collaborators, Affiliations

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

Sizheng Steven Zhao et al. Rheumatology (Oxford). .

Abstract

Objective: To investigate the association between socioeconomic deprivation and outcomes following TNF inhibitor (TNFi) treatment.

Methods: Individuals commencing their first TNFi in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA) and Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS) cohort were included. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation and categorized as 20% most deprived, middle 40% or 40% least deprived. DAS28-derived outcomes at 6 months (BSRBR-RA) and 3 months (BRAGGSS) were compared using regression models with the least deprived as referent. Risks of all-cause and cause-specific drug discontinuation were compared using Cox models in the BSRBR-RA. Additional analyses adjusted for lifestyle factors (e.g. smoking, BMI) as potential mediators.

Results: 16 085 individuals in the BSRBR-RA were included (mean age 56 years, 76% female), of whom 18%, 41% and 41% were in the most, middle and least deprived groups, respectively. Of 3459 included in BRAGGSS (mean age 57, 77% female), proportions were 22%, 36% and 41%, respectively. The most deprived group had 0.3-unit higher 6-month DAS28 (95% CI 0.22, 0.37) and were less likely to achieve low disease activity (odds ratio [OR] 0.76; 95% CI 0.68, 0.84) in unadjusted models. Results were similar for 3-month DAS28 (β = 0.23; 95% CI 0.11, 0.36) and low disease activity (OR 0.77; 95% CI 0.63, 0.94). The most deprived were more likely to discontinue treatment (hazard ratio 1.18; 95% CI 1.12, 1.25), driven by ineffectiveness rather than adverse events. Adjusted estimates were generally attenuated.

Conclusion: Socioeconomic deprivation is associated with reduced response to TNFi. Improvements in determinants of health other than lifestyle factors are needed to address socioeconomic inequities.

Keywords: RA; deprivation; index of multiple deprivation; socioeconomic position; treatment response.

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Figures

Figure 1.
Figure 1.
Models comparing 6-month treatment response across groups of socioeconomic deprivation in BSRBR-RA. BSRBR-RA: British Society for Rheumatology Biologics Register for RA; DAS28: 28-joint disease activity score; OR: odds ratio
Figure 2.
Figure 2.
Probability of drug discontinuation compared across groups of socioeconomic deprivation in BSRBR-RA. BSRBR-RA: British Society for Rheumatology Biologics Register for RA; HR: hazard ratio; IMD: Index of Multiple Deprivation
Figure 3.
Figure 3.
Models comparing 3-month treatment response across groups of socioeconomic deprivation in BRAGGSS. BRAGGSS: Biologics in RA Genetics and Genomics Study Syndicate; OR: odds ratio
See this image and copyright information in PMC

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