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Abstract
Background Clinical response in patients with rheumatoid arthritis (RA) using biologics is well-known. However, there is no direct comparison between biologics in cohorts of patients with long-standing RA in real-life settings, which could have implications in treatment decisions and health economics.
Objectives The aim of this study was to describe a direct comparison in effectiveness between three different biological agents in their mechanism of action and its application in patients with long-standing RA in a cohort of real-life.
Methods A descriptive retrospective study was performed. Were included 242 patients with at least 12 visits to rheumatologist in last 24 months. Clinical follow-up was according to DAS28: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients and the aim of the study was to analyze of patients who were in MDA/SDA disease activity how many reached a Rem/LDA status. Patients with diagnosis of RA and using Abatacept, Adalimumab and Rituximab were involved. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson's statistics.
Results 242 patients were included, 201 (83%) women and 41 (17%) men. Mean age was 58±10 years; patients with RA and using Abatacept, Adalimumab and Rituximab were involved and treatments were distributed as follows: Abatacept 72 (30%), Adalimumab 96 (40%) and Rituximab 74 (30%); At 24 months was observed an increase in percentage of patients in Rem/LDA and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. For Abatacept at beginning the mean DAS28–3.8 and 24 months later DAS28–2.7; for Adalimumab at beginning the mean DAS28–3.2 and 24 months later DAS28–2.6; for Rituximab at beginning the mean DAS28–3.7 and 24 months later DAS28–2.5; although the HAQ reduction had clinical relevance there was no statistically significance. Between these biologics were not differences statistically significant in effectiveness. A very important issue was that at the end of the follow-up there was no patients in severe disease activity.
Conclusions Study shows no significant differences in effectiveness between three different biological agents in their mechanism of action and its application analyzed, but there was a clear improvement in all patients with respect to basal disease activity, which proves effectiveness of implementation of a T2T strategy in patients with long-standing RA independent of biological.
Disclosure of Interest None declared