Which Patients With Rheumatoid Arthritis Are More Likely to Experience Multiple Biologic Failures?

A study examined factors associated with multiple failures to biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with rheumatoid arthritis (RA). They concluded that younger age and the presence of erosions were independent risk factors. “Nowadays, despite the increasing number of therapeutic tools available, the successful treatment of certain RA patients remains particularly challenging for clinicians,” the authors explained in their reasoning for undertaking the study. “This is in part due to the severity of the disease, but additionally may be related to the tendency of rheumatologists to cycle or switch therapies in an attempt to achieve strict disease control, following the treat-to-target recommendations. The percentage of patients who fail to respond to multiple bDMARDs in clinical practice is sufficiently relevant to warrant special focus due to the intrinsic difficulties of achieving good disease control.” Patients with RA were identified from the La Paz University Hospital RA Registry. All patients in the current analysis started a bMARD between 2000 and 2019. Multi-refractory patients (MR-patients) were those who had an insufficient response to at least three bDMARDs or two bDMARDs that had different mechanism of action. Non-refractory patients (NR-patients) were those who attained low disease activity or remission, per the Disease Activity Score in 28 joints (DAS-28), with the first bDMARD and maintained it for at least five years. Of 402 total patients identified, 41 were MR-patients (10%) and 71 were NR-patients (18%). The following factors were independently correlated with being MR-patients to bDMARDs on multivariate analysis: being younger (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.90–0.99), presence of erosions (OR, 3.26; 95% CI, 1.18–9.00), and higher baseline DAS-28 (OR, 2.29; 95% CI, 1.39–3.76) before initiating the first bDMARD, and achieving a delta-DAS-28 <1.2 six months after initiating the first bDMARD (OR, 11.12; 95% CI, 3.34–26.82). The study was published in Arthritis Research & Therapy. The researchers stated in their conclusion that “our findings highlight the fact that a universal standard definition of multi-refractoriness is needed if further studies are going to be capable of establishing predictors to multiple bDMARD failure.”