Background Management of rheumatoid arthritis is complex. Better disease control results in better patient outcomes. There are clear guidelines and focused strategy for achieving low disease activity or remission in RA patients, that should be applied in routine clinical practice.
Objectives To evaluate disease activity and efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) used to achieve treatment aim (remission or low disease activity) according to treat-to-target strategy, among rheumatoid arthritis (RA) patients in daily practice in Serbia.
Methods Consecutive RA patients treated in 4 participating Serbian clinics during November and December 2014 were included in the study. Data were collected on the basis of the last completed assessment of disease, among patients to whom bDMARD was added to previously used conventional synthetic disease-modifying antirheumatic drug (csDMARD) and have been treated with this strategy for at least 6 months. The disease activity score (DAS28) was used to classify patients into the disease activity states of remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA). Choice of therapy was at the discretion of the treating clinician.
Results A total of 223 patients with median disease duration of 5 years were analyzed. To 88.4% of patients bDMARD was added due to HDA. Majority of the patients were previously treated with Methotrexate alone or in combination with another csDMARD (75.9% and 12.3%, respectively), 5.4% with Sulfasalazine and 6.4% with other csDMARDs. 50.7% of the patients were receiving Enbrel, 21.1% Humira, 17.0% Actemra, 9.0% Simponi, 1.8% Remicade and 0.4% MabThera. DAS28 scores were recorded for all patients, with 36.0% in remission, 27.9% in LDA, 31.1% in MDA and 5.0% in HDA. For 10.3% of patients who did not achieve treatment target (those with MDA and HDA), was recorded secondary loss of efficacy. If primary or secondary inefficacy were recorded, the choice of 2nd bDMARD will be at the discretion of the treating clinician.
Conclusions Cross-sectional assessment of this cohort of Serbian RA patients treated with bDMARDs showed a significant improvement in disease control for most of the patients, but still found a large proportion remain in moderate and high disease activity. Substantial future health burdens in this group of patients may be reduced by improving disease control with proper management of RA patients with increased focus on treat-to-target strategy with tight control and individual approach.
Acknowledgements The study was initiated and sponsored by Roche d.o.o. Serbia.
Disclosure of Interest None declared