Background With recent astonishing advances in drug therapy, “remission” has become a realistic therapeutic goal in RA. Among them the most powerful driving force might be the advent of “biologics (Bio)” targeting cytokines and lymphocytes. In fact, they have shown outstanding efficacy and become a master of drug. However, some issues remain to be addressed and resolved, including adverse effects such as serious infections, therapeutic failure and high cost.
Objectives To examine the causes of discontinuation of Bio in 2,274 Japanese RA patients treated with Bio under practical circumstances.
Methods The causes of discontinuation of Bio-use were analyzed by using the data from the “NinJa”, one of the largest Japanese RA patient registry established since 2002 and now consists of the clinical data of 10,368 patients from more than 30 hospitals.
Results 2,274 (22.1%) of the total registered patients were treated with some Bio. Among them, 352 (15.5%), 940 (41.3%), 258 (11.3%), 63 (2.8%), 459 (20.2%), and 206 (9.1%) of the patients were treated with IFX, ETN, ADA, TCZ and ABT respectively. The cases (percentages) of discontinuation of Bio-use were 62 (17.6%), 71 (7.6%), 55 (21.3%), 39 (8.5%), and 20 (9.7%) in IFX, ETN, ADA, TCZ and ABT respectively. The causes of discontinuation were analyzed and shown in the following Table. Regarding “Failure”, the discontinuation rate was significantly higher ADA. In “Adverse effects”, there was no significant difference among all Bio, although a tendency of higher rate was observed in IFX and ADA. In contrast, it was relatively low in ABT. In addition, the discontinuation due to “Remission” was significantly higher in IFX compared to other Bio.
Conclusions There were some characteristics in the causes of discontinuation among Bio. It seems to be feasible to achieve Bio-free remission in some Bio. With further investigations, these findings might provide us a clue to know how and which cases can be achieved Bio-free remission.
Acknowledgements This study was supported by both the grants of NHO (National Hospital Organization) and the Ministry of Health, Welfare and Labor.
Disclosure of Interest None Declared