Background The application of the “treat-to-target” strategy in rheumatoid arthritis requires being proactive in the management of the disease to get the better outcomes. The treatment changes in daily practice are directed to improve the efficacy and/or tolerance, and also reduce the toxicity.
Objectives The present study aimed to describe the percentage of patients who suffered a change in their synthetic DMARD regimen due to loss of efficacy (LoE), adverse events (AEs), intolerance, and other reasons. Also the therapeutic strategies chosen by rheumatologists for management of synthetic DMARD after treatment failure were evaluated.
Methods This retrospective, observational and multicenter study included patients diagnosed with RA (fulfillment of the ACR/EULAR 2010 diagnostic criteria) from 2008 to 2012, who have started on at least one synthetic DMARD within this period. Patients were included in a routine clinical visit performed in 2014. Patient clinical characteristics and previous/current medications for RA were retrospectively collected from patients' medical records after the consensus of the participant rheumatologists in the study. Descriptive analysis of the data retrieved at the study visit in 2014 is presented.
Results 12 sites in Andalucía (Spain) included 301 patients (mean age: 56.6±14.0; female: 71%; RA duration: 3.6±1.5), whose clinical characteristics are shown in the table. 57% of patients have received a single synthetic DMARD, with metothrexate (MTX) (57%), leflunomide (20%) and hydroxychloroquine (9%) as the most commonly DMARDs prescribed as monotherapy. During the study period, 69% of patients suffered ≥1 change in the first- or subsequent-line DMARDs for AEs, intolerance or LoE. Of the 341 changes registered, 42% were due to LoE, 28% due to AEs (31% liver disorders, 19% gastrointestinal symptoms), 14% due to intolerance, and the remaining 16% due to the following reasons: patient preference, lack of adherence, pregnancy plans and loss of follow-up. DMARD was definitely and temporarily interrupted in 35% and 8% of the cases, respectively. Both the addition of and the switch to another conventional DMARD occurred in 11%, and DMARD dosage was adjusted in 28% of the cases.
Conclusions In clinical practice, MTX was the main DMARD prescribed for initial treatment. Most of all changes made in DMARD therapy (84%) were due to lack of efficacy, AEs and intolerance. Definitely interruptions (35%) and dosage adjustments (28%) were the therapeutic strategies mainly chosen by rheumatologists.
Disclosure of Interest None declared