Background The role of disease worsening or flares in taking important clinical decisions, such as dose adjustments or treatment change, is poorly understood in patients suffering from severe RA treated with TNF inhibitors over long periods of time.
Objectives To determine whether the prevalence of flare episodes can predict the response to anti-TNF treatment over time and the change to second line therapy.
Methods In this longitudinal, observational, population-based, cohort study we included a total of 400 patients. Data were retrieved from the National Health Insurance House (NHIH) database (2002-2011). Flare events were defined according to OMERACT criteria as increase in disease activity score DAS28 >3.2 or >0.6 if DAS28 >3.2. Prevalence of flare episodes, DAS28 response rates and EULAR response rates were calculated every six months.
Results In our analysis, 379 (94.5%) patients presented 672 flare episodes (prevalence 168% in the analysed population).
Conclusions In current clinical practice in Romania, a single flare episode in patients with a MDA should prompt change to second line therapy, including biological agents with other mechanisms. Our real life results, based on data collected before 2012, support OMERACT flares criteria and ACR/EULAR recommendations, emphasizing strict patient evaluation and tight control in the first 1-3 months after anti-TNF treatment initiation.
Disclosure of Interest None Declared
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