Background Disease remission is a key target while managing patients with Rheumatoid Arthritis (RA).
Objectives To assess the patterns of disease remission among Rheumatoid Arthritis (RA) patients recently treated with biologic therapies in the United States.
Methods A multi-center medical chart-review study of RA patients was conducted among physicians (majority: rheumatologists) in hospitals/private practices to collect de-identified data on patients who are currently on a biologic or recently discontinued a biologic within past 3-months. Physicians were screened for practice-duration and patient-volume and recruited from a large panel to be geographically representative of the US. Patient charts of ∼10 successive patients visiting each center/practice during study period were selected. Physicians abstracted patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status (incl. assessment of “disease remission”, per physician clinical judgment). This retrospective de-identified data collection method met the criteria for IRB exemption under federal regulation 45 CFR 46.101(b)(4).
Results In 4Q2011, 109 physicians abstracted 851 eligible RA patient charts; patient mean age: 51yrs, female: 73%; 69% and 24% were on 1st line and 2nd line biologic respectively. Overall, 48% of patients were in remission. Remission rate differed by biologic lines: 1st line: 51%, 2nd line: 45%, 3rd line: 26%, 4th line: 27%. Among those with lab measures, results differed between those in remission vs. those who were not: mean ESR (mm/h): 18.9 vs. 37.2, mean CRP (mg/dl): 1.6 vs. 5.3, Rheumatoid Factor (% positive): 87% vs. 89%, Anti-CCP (% positive): 74% vs. 79% and HLA-B27 (% positive): 7% vs. 9%. Among those with data, recent (mean) disease severity scores differed between those in remission vs. those who were not: Tender Joint Count: 1.6 vs. 6.3, Swollen Joint Count: 0.8 vs. 4.8, 100mm VAS score: 18.9 vs. 39.8, HAQ: 0.6 vs. 1.5 and DAS28: 2.2 vs. 4.1.
Conclusions More than half of the patients were not in remission in this cohort of RA patients in the US who were treated with a biologic recently; they experienced disproportionate level of disease burden. As the line of treatment increased, proportion of individuals achieving remission decreased. These observed patterns warrant further scrutiny to determine the best practices and improve remission rates, thereby alleviating patient burden.
Disclosure of Interest : None declared