TOP LINE:

Early escalation to biologic therapies after failure of targeted methotrexate therapy in patients with rheumatoid arthritis (RA) does not significantly reduce the risk of developing difficult-to-treat RA.

METHODOLOGY:

• Researchers conducted a retrospective analysis including 722 patients with new-onset RA (mean age 60 years; 72% women) who were identified in a cohort at the IRCCS Policlinico San Matteo University Hospital in Italy and followed up for at least 3 years afterwards. diagnosis.
• Patients were initially treated with methotrexate, with a switch to targeted biologic or synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in case they did not reach the therapeutic goal.
• Follow-up of patients who started b/tsDMARD treatment took place every 2 months for the first 6 months, then every 4 months, with the aim of achieving low disease activity (disease activity score on 28 joints, < 3.2).
• The effectiveness of each DMARD was assessed using drug survival rates, and the development of difficult-to-treat RA was assessed using the European Alliance of Rheumatology Associations criteria.

TAKE AWAY:

• The retention rate for the first b/tsDMARD decreased from 72.3% at 12 months to 41.6% at 60 months, indicating a decline in treatment persistence over time.
• Early switching to biologic therapies did not significantly reduce the risk of difficult-to-treat RA, with 29% of patients meeting criteria after a median follow-up period of 72.6 months.
• Patients with higher disease activity and a higher number of swollen joints at the start of biologic treatment were more likely to develop resistance to the treatment.
• Shorter disease duration at b/tsDMARD initiation, greater number of swollen joints, greater pain scores, and negative autoantibody status were identified as independent predictors of RA difficult to treat.

IN PRACTICE:

“Early initiation of treatment after failure of targeted therapy with MTX (methotrexate) may not prevent the development of D2T (difficult to treat) in RA patients,” the authors conclude.

SOURCE:

The study was led by Bernardo D’Onofrio, MD, and Ludovico De Stefano, MD, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy. It was published online on November 8, 2024, at Arthritis Research and Therapy.

BOUNDARIES:

Progression to b/ts DMARDs was not strictly guided by disease activity scores, potentially reflecting clinical practice. Additionally, the study did not account for socioeconomic factors or adherence, which may have influenced treatment outcomes.

DISCLOSURES:

This study was funded by a grant from the IRCCS Policlinico San Matteo Foundation. One author reported receiving grants/research support and personal fees and two authors reported receiving personal fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.