Real-World Analysis of Initial Clinical Response and Future Outcomes Among Patients with Rheumatoid Arthritis Initiating and Remaining on a First-Line Tumor Necrosis Factor Inhibitor in the United States

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This study aimed to evaluate a subsequent treatment response among patients with rheumatoid arthritis (RA) who initiated and remained on a first-line tumor necrosis factor inhibitor (TNFi) after achieving or not achieving an initial response. This real-world, retrospective cohort study included patients with RA in moderate/high disease activity (MDA/HDA), defined by Clinical Disease Activity Index (CDAI) score > 10, who initiated a first-line TNFi and remained on therapy for ≥ 12 months. Data were analyzed according to the time of initial evaluation: 3 months (N = 1215) or 6 months (N = 1318). Primary outcome: proportion of patients achieving low disease activity (LDA)/remission in CDAI (≤ 10) at the initial evaluation; secondary outcome: proportion of patients achieving minimal clinically important difference (MCID) in CDAI. Patients were categorized as responders or nonresponders according to outcome achievement, then analyzed for subsequent response at 12 months and maintenance of initial response through 12 months. After 3 months, 65.9% of patients were in MDA/HDA. Among these nonresponders, 73.5% remained in MDA/HDA at 12 months and 64.2% failed to improve through 12 months. Of patients in LDA/remission at 3 months, 27.0% lost their response at 12 months. Among the 59.2% of nonresponders at 6 months, 80.1% were in MDA/HDA at 12 months and 74.5% never improved through 12 months. For patients in LDA/remission at 6 months (40.8%), 23.4% subsequently lost their response at 12 months. Similar trends were observed for achievement of MCID in CDAI. In patients with RA treated with a first-line TNFi, most patients who did not achieve a treatment target at an initial evaluation also failed to achieve the treatment target at 12 months. Therefore, evaluating treatment as early as 3 months after initiation may help indicate future clinical improvements and could serve as a reasonable timepoint to consider changing therapy for patients with an inadequate response. This study looked at patients with rheumatoid arthritis (RA) who started taking a medication used to treat RA, a tumor necrosis factor inhibitor (TNFi). These patients had never used other similar medications and had moderate to high levels of disease. The researchers were interested in measuring the treatment response of patients who continued to take a TNFi for 12 months on the basis of their initial treatment progress after either 3 or 6 months. The severity of a patient’s symptoms was measured at an initial visit (either 3 or 6 months) and at a subsequent visit (12 months) to classify the level of disease activity. After 3 months of treatment with a TNFi, most patients (65.9%) still had moderate or high levels of disease activity, and 73.5% of these patients did not improve after 12 months. For those who had low disease activity or were in remission at 3 months (34.1%), 27.0% of these patients saw their symptoms worsen by 12 months. After 6 months of treatment with a TNFi, 59.2% of patients still had moderate or high disease activity. Of these patients, 80.1% did not improve at 12 months. For those who had low disease activity or were in remission at 6 months (40.8%), about 23.5% had their condition worsen by 12 months. Overall, the study showed that if patients treated with a TNFi did not improve initially, they were unlikely to improve later, and that nearly a quarter of patients who improved initially with a TNFi saw their condition worsen.

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