Objectives The objective of this study was to analyze the efficacy of biologic agents and their effects on the activities of daily living (ADL), health-related quality of life (HRQoL), and depression in patients who have switched between biologic agents for the treatment of rheumatoid arthritis (RA).
Methods A total of 108 RA patients were assessed prior to treatment and 30 weeks after initiating the first biologic therapy (Group 1). Infliximab, etanercept, adalimumab, tocilizumab, abatacept, and golimumab were used as biologic therapies, and the choice of treatment was at the physicians’ discretion.
Age, gender, and steroid dosage were recorded for each participant, and the disease activity score (DAS) 28/ESR4, the ADL (modified Health Assessment Questionnaire; mHAQ), the HRQoL questionnaire (Short Form (SF)-36), and the depression scale (The Hamilton Depression rating scale (HAM-D)) were administered to the patients. Thirty-five patients were assessed following the initiation of a second biologic therapy (Group 2), and 16 patients were assessed following a third therapy (Group 3), each using similar assessments. The primary endpoint was the assessment of clinical improvement, and the secondary endpoints were the assessments of changes in the ADL, HRQoL, and depression scales.
Results After 30 weeks of administration, the DAS28 scores changed from 4.7 ± 1.4 to 2.9 ± 1.3 (p<0.001, Group 1), from 4.8 ± 1.1 to 2.9 ± 1.2 (p<0.001, Group 2), and from 4.3 ± 1.5 to 2.3 ± 1.1 (p<0.001, Group 3), respectively. The mHAQ scores changed from 0.49 ± 0.51 to 0.31 ± 0.44 (p<0.001), from 0.49 ± 0.43 to 0.32 ± 0.40 (p=0.0087), and from 0.48 ± 0.54 to 0.32 ± 0.47 (p=0.051) in Groups 1, 2, and 3, respectively. The HAM-D scores changed from 5.8 ± 4.9 to 4.2 ± 4.4 (p=0.0023), from 7.4 ± 5.2 to 3.2 ± 2.9 (p=0.003), and from 8.5 ± 7.2 to 3.6 ± 3.2 (p=0.0013), respectively. All of the SF-36 categories showed significant improvements (p<0.001) in Group 1. Although emotional role functioning did not improve in Group 2 (p=0.28), all other SF-36 categories improved in Group 2. None of the SF-36 categories showed significant improvement (p<0.001) in Group 3. The age, gender, and steroid dosage were not significantly different between Groups 1, 2, and 3.
Conclusions In this study, the first and second biologic agent treatments had high efficacy and improved the ADL, HRQoL, and depression scores in RA patients. Although the third biologic treatment showed significant improvements in efficacy and depression, no significant improvements of the ADL or HRQoL were observed. Because more time was required for the third biologic therapy to show efficacy, the ADL and HRQoL decreased.
Disclosure of Interest Y. Miwa Grant/research support from: Tanabemitsubishi, Wyeth, Abbott, Chugai, Eizai, S. Isojima: None Declared, M. Umemura: None Declared, H. Tsukamoto: None Declared, T. Tokunaga: None Declared, H. Furuya: None Declared, R. Yanai: None Declared, K. Otsuka: None Declared, R. Takahashi: None Declared, K. Wakabayashi: None Declared, N. Yajima: None Declared, T. Kasama: None Declared, M. Hosaka: None Declared