Background There is a growing emphasis on treating patients to a target level of low disease activity (LDA) or remission in order to improve outcomes associated with rheumatoid arthritis (RA).
Objectives Our objective was to examine trends in the achievement of LDA over the past decade among RA patients receiving their first, second and third or more biologic agent.
Methods Using the Corrona registry, we identified initiators of biologic therapy (stratified by prior experience: 1st, 2nd, ≥3rd) in distinct periods of calendar time over the last decade (2002–2004, 2005–2007, 2008–2010, 2011–2013) with moderate or high disease activity at the time of the initiation based on the Clinical Disease Activity Index (CDAI >10), and a follow-up CDAI measured at 1 year (±3 months). The primary outcome was achievement of LDA (CDAI ≤10) at 12 months. Trends over time between the groups were examined using Chi square tests. Multivariable logistic regression models were performed adjusting for baseline covariate.
Results We identified 6,534 biologic initiators (1st: 2,769, 2nd: 2181, ≥3rd: 1584) who met inclusion criteria. Between 2011 and 2013, LDA occurred in 51%, 42% and 35% of those initiating their 1st, 2nd and ≥3rd biologic respectively. There was a significant trend over time in achievement of LDA in those initiating their first biologic. In adjusted models, treatment in the earlier time periods for those who initiated their 1st or ≥3rd biologic was associated with a reduced likelihood of achieving LDA (Table).
Conclusions In the latest time period, achievement of LDA was influenced by biologic experience (50% in 1st biologic vs. 35% ≥3rd biologic initiation). Patients who initiated their 1st or ≥3rd biologic in earlier time periods had a reduced likelihood of achieving LDA (Table). Additional investigation is needed to understand the factors contributing to the trend in improved disease as well as the barriers in order to inform efforts to further increase the proportion of patients who achieve LDA.
Acknowledgement This study was funded by the Corrona Research Foundation.
Disclosure of Interest L. Harrold Grant/research support from: Pfizer, Consultant for: Roche, Employee of: Corrona, LLC, J. Palmer: None declared, J. Curtis Grant/research support from: Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, Abb Vie, Consultant for: Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, Abb Vie, J. Greenberg Shareholder of: Corrona, LLC, Consultant for: AstraZeneca, Celgene, Genentech, Janssen, Novartis and Pfizer, Employee of: Corrona, LLC, D. Pappas Employee of: Corrona, LLC, Paid instructor for: Novartis, J. Kremer Shareholder of: Corrona, LLC, Consultant for: AbbVie, Amgen, BMS, Genentech, GSK, Lilly, Medimmune, Pfizer, Sanofi, Employee of: Corrona, LLC, Speakers bureau: Genentech (for non-branded talk only)