Background Rheumatoid arthritis (RA) is an autoimmune disease with involvement of small and large joints. Biologic agents (BAs) represent treatment options if disease is not adequately controlled by DMARDs. Treat-to-target strategy aims to improve the outcome of patients with RA and rapidly reduce disease activity by using properly and aggressively all the therapeutic options.
Objectives To estimate the efficacy of proper initiation of BAs, according to EULAR therapeutic algorithm, in patients with RA compared to patients with delayed initiation of biologic treatment.
Methods This is a retrospective study of 1.494 patients' files (1.173 women and 321 men, mean age at disease initiation 48.9 years). Demographic and clinical data were recorded during every patient's visit. There were 355 patients with initiation of biologic treatment during their follow-up in our department. Disease activity was classified by DAS-28 score at 3, 12 months and at the end of treatment with the first BA. Effectiveness of first BA was analyzed, taken in to account the EULAR criteria for response to treatment.
Results There were 105 patients with proper and 250 patients with delayed initiation of BAs. In the first group, mean duration of BA administration was 30.8 months while DAS-28 before treatment was 4.83 and after treatment 2.55. In the second group mean duration of BAs was 51.0 months with DAS-28 before and after treatment 5.08 and 3.21 respectively. After 3 months of treatment, 59/100 (59%) patients with proper induction of BA achieved remission or low disease activity compared to 100/239 (41.8%) patients with delayed use (p=0.004). After 12 months of treatment, 52/66 (78.8%) and 111/181 (61.3%) patients from two groups respectively achieved remission or low disease activity (p=0.01). At the end of first biologic treatment, 50/105 (47.6%) patients, with proper induction of BAs, had remission, 27/105 (25.7%) low disease activity, 12/105 (11.4%) medial and 16/105 (15.2%) high disease activity. In contrary, 78/250 (31.2%) patients with delayed use achieved remission, 48/250 (19.2%) low, 56/250 (22.4%) medial and 68/250 (27.2%) high disease activity. Comparison between the two groups revealed a statistically significant advantage of proper initiation of BAs, as it concerns remission and/or low disease activity (p=0.001).
Conclusions Treat-to-target treatment, according to EULAR therapeutic algorithm for BAs administration, offers a rapid and better long-term outcome to patients with RA.
Disclosure of Interest : None declared