Single-centre experience of refractory rheumatoid arthritis

Area of Science:

• Rheumatology
• Clinical Immunology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) management often involves sequential use of targeted therapies (TTs).
• Identifying patients refractory to multiple TTs (RefRA) is crucial for optimizing treatment strategies.
• Understanding patterns of drug failure in RA is essential for improving patient outcomes.

Purpose of the Study:

• To determine the proportion of RA patients refractory to multiple TTs in a real-world setting.
• To describe drug sequencing patterns leading to refractory RA (RefRA).
• To identify if a subgroup of RefRA patients exhibits primary lack of efficacy to successive TTs.

Main Methods:

• A real-world cohort from a tertiary rheumatology referral center was analyzed.
• Refractory RA (RefRA) was defined as failure of two or more TT classes.
• Patients were categorized into mild, moderate, or severe refractory disease based on TT classes failed.

Main Results:

• 172 patients (over 10% of the TT-exposed cohort) were identified as RefRA.
• The median number of TT exposures was four.
• 15% of RefRA patients had severe refractory disease, and 6% showed no response to any TT.

Conclusions:

• A small proportion of RA patients exhibit true refractory disease to multiple TTs.
• The majority of patients failing multiple therapies do so due to a combination of inefficacy and adverse events.
• Further research is needed to understand primary non-response in a subgroup of RefRA patients.