Background Biologics have greatly improved the management of rheumatoid arthritis (RA), demonstrating efficacy and safety in alleviating symptoms, inhibiting bone erosion, and preventing loss of function.1 The current study hypothesis was that despite significant improvement in patient (pt) outcomes since the introduction of biologics, significant unmet need and burden of illness remains.
Objectives The main objective was to test our primary hypothesis. Secondary objectives were to explore patterns of physician use of disease activity measures and compare degree of reported unmet need as ascertained by subjective physician assessment and objective disease activity measures.
Methods Descriptive analyses of the following outcomes were performed using ADELPHI RA Disease Specific Program (DSP) data for US and EU5 pts who had been receiving biologic therapy ≥3 months: remission based on DAS28 ESR (<2.6), physician-reported remission, disease severity, satisfaction with current control of pt's RA, and rating (100-point VAS) of pt's overall condition. Data were evaluated for the overall population receiving biologics and separately for pts receiving 1st- and 2nd-line biologics.
Results After ≥3 months on biologics (n=1299), 56% of pts were in remission based on physician judgement, while 31% were in remission based on DAS28 ESR (<2.6; Table). Objective measures of disease activity were not calculated for 30% (389/1299) of pts overall (higher in the US, 63% [274/437] vs EU5, 13% [115/862]; P<0.0001). Physicians reported that 29% of pts had moderate to severe disease; 16% of pts had no improvement in disease severity or worsened with treatment; and 41% of pts taking biologics were in worse overall condition than the average (64.8 [100-pt VAS]) for all RA pts enrolled in the DSP (n=3379). 23% (304/1299) of physicians were dissatisfied with current control of the pt's RA on biologic treatment. Levels of unmet need were similar for 1st-line biologic pts relative to the overall group of biologic-treated pts and higher for 2nd-line biologic pts.
Conclusions There are significant unmet needs among RA pts on biologic treatment, regardless of line of therapy, suggesting the need for biologics with novel mechanisms of action. Remission based on physician judgement appeared to be over-reported as compared to remission indicated by disease activity measure DAS28. Clinical disease activity measures were not used consistently by physicians. Future study is warranted to explore whether under-utilization of disease activity measures is associated with the discrepancy between physician subjective judgement and clinical measurement.
Smolen JS, et al. Ann Rheum Dis. 2014;73(3):492–509.
Disclosure of Interest S. Peterson Shareholder of: Janssen, Employee of: Janssen, E. Sullivan Employee of: Adelphi Real World, D. Kielar Shareholder of: Janssen, Employee of: Janssen, N. Li Employee of: Janssen