Study Finds Significant Unmet Needs Remain With RA Treatment

Despite progress in the successful treatment of patients with rheumatoid arthritis (RA) who are using conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs), a Greek study has found that a considerable number (20.9%) of patients are still not achieving low disease activity (LDA) despite having been treated following established recommendations for RA therapy.

The study was published in the June 15, 2018, issue of the Annals of the Rheumatic Diseases.¹

The data from the study are based on the experience of 538 patients at a Greek outpatient RA clinic who were followed from January 2006 to December 2017. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for early RA, had disease duration for less than 1 year, were csDMARD- and bDMARD-naïve, and were treated according to EULAR/ACR recommendations and strategies for RA.

The csDMARDs used to treat patients were:

• Methotrexate (MTX)
• Leflunomide (LFN)
• Sulfasalazine (SSZ)
• Hydroxychloroquine (HCQ)

The following bDMARDs were used:

• Abatacept
• Adalimumab (ADA)
• Certolizumab
• Etanercept (ETN)
• Golimumab
• Infliximab (INF)
• Rituximab
• Tocilizumab

Small doses of steroids were also administered. During follow up, laboratory findings, treatment decisions and strategies, any drug reactions, and reasons for termination or changes in treatment strategies were recorded. Disease activity was measured with the Disease Activity Score-28 (DAS-28) using the erythrocyte sedimentation rate.

All patients received 1 csDMARD for at least 6 months. The csDMARD of first choice was MTX (58%), followed by LFN (32%), HCQ (8%), and SSZ (2%); the bDMARD of first choice was INF (37%) followed by ETN (32%) and ADA (31%). Seven patients never received bDMARDs because of comorbidities.

The final results were based on data from 517 patients (14 patients were lost; 7 never received bDMARDs). Among the remaining 517 patients, 324 patients (66%) were treated with csDMARDs as monotherapy or in combination, with or without steroids, with significant clinical improvement and sustained low-disease activity (LDA). However, 11 patients (3.2%) from this group neither achieved LDA nor received bDMARDs due to comorbidities. A total of 175 (34%) patients were treated with bDMARDs with or without csDMARDs and/or steroids and the majority demonstrated sustained LDA for a long period of time. Of this group, 31 patients (17.7%) never achieved LDA despite switching and receiving all bDMARDs. Thus, a total of 20.9% of the patients never achieved LDA.

The researchers conclude that their real-life study estimates the significant size of the unmet need among patients with RA despite adherence to established ACR/EULAR—endorsed treatment methods.

Reference

1. Kaltsonoudis E, Pelechas E, Voulgari PV, Drosos AA. FrI010 Unmet needs in the treatment of rheumatoid arthritis. An observational study and a real-life experience from a single university centre. Ann Rheum Diseases. 2018;77:594-595.