If European League Against Rheumatism guidelines are followed, when a patient with rheumatoid arthritis (RA) does not reach remission or a state of low disease activity after 6 months of treatment, then the patient’s treatment should be modified regardless of the drug therapy being used (biologic or small molecule).
Approximately 1% of the global population has rheumatoid arthritis (RA), and treating RA is costly, especially when biologic drugs are necessary after the failure of small-molecule drugs. A recent study conducted in Poland sought to understand how patients diagnosed with RA progressed through treatments for their disease.
Using the Polish National Health Fund data, researchers identified 1167 patients with RA who began therapy in 2009. The patients, who were followed until 2014, initiated treatment with the following drugs financed under the government’s public payer program: the small-molecule leflunomide (53.6%) and the biologics adalimumab (5.8%), etanercept (14.4%), infliximab (23.1%), and rituximab (3%).
During the first year of treatment, 80.9% of patients continued to receive adalimumab, 85.4% continued to receive etanercept, 84.1% continued to receive infliximab, and 74.9% continued to receive leflunomide. In total, 186 patients (16%) stopped or paused therapy after the first year, and during the 2 following years, 754 patients (65%) did so.
The most therapy changes occurred for patients who had started treatment with infliximab; after year 6, 96% of patients had changed from infliximab to another option. Adalimumab had the second highest frequency of changes, with 85% of patients changing drugs by year 6.
The authors of the study say that, if European League Against Rheumatism guidelines are followed, when a patient with RA does not reach remission or a state of low disease activity after 6 months of treatment, then the patient’s treatment should be modified regardless of the drug therapy being used (biologic or small molecule). However, according to their findings, most therapies were continued for 1 year or more before discontinuation. In total, say the authors, between 50% and 70% of the patients followed in this study remained on an RA treatment for an inappropriate length of time.
Tłustochowicz M, Śliwczyński AM, Brzozowska M, Teter Z, Marczak M. Sequentiality of treatment in the rheumatoid arthritis drug programme in the years 2009-2014. Arch Med Sci. 2018;14(3):569-571. doi: 10.5114/aoms.2016.58924.