Real-World Treatment and Care Patterns in Patients With Rheumatoid Arthritis Initiating First-Line Tumor Necrosis...

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) treatment guidelines emphasize achieving low disease activity or remission.
• Treatment adjustments are recommended for patients failing to reach target disease activity levels.
• Tumor necrosis factor inhibitors (TNFi) are a common first-line biologic therapy for RA.

Purpose of the Study:

• To evaluate the real-world utilization of disease activity measures in RA patients starting first-line TNFi therapy.
• To assess treatment discontinuation and switching patterns among these patients.
• To identify gaps in monitoring and treatment strategies for RA management.

Main Methods:

• Analysis of adult RA patient data from the American Rheumatology Network (2014-2021).
• Assessment of baseline disease activity score (CDAI or RAPID3) recording at TNFi initiation.
• Evaluation of discontinuation reasons and subsequent advanced therapy choices in patients with moderate to severe RA.

Main Results:

• Less than half (44.8%) of TNFi initiators had recorded CDAI/RAPID3 scores at baseline.
• Among patients with moderate/severe RA, 52% discontinued their first TNFi.
• Reasons for discontinuation varied, with many patients switching to other TNFi or non-TNFi biologics, sometimes despite citing lack of efficacy.

Conclusions:

• A significant proportion of RA patients initiating first-line TNFi lack baseline disease activity assessments.
• Treatment cycling with TNFi is common, even when lack of efficacy is the stated reason for discontinuation.
• Objective monitoring and timely therapeutic switching are crucial for effective RA management.