Background Rheumatoid arthritis (RA) treatment is usually done with non-biological disease-modifying antirheumatic drugs (DMARDs), but the addition of a biological DMARD can be necessary. Biological drug therapy is usually prescribed following failure to achieve remission of the morbidity with one or more non-biological DMARDs. However, there is the possibility of using them as a first line in the initial phase, which there is the possibility of potentially altering its course or even reverting it to normality.

Objectives To determine the time Colombian patients with rheumatoid arthritis (RA) are treated with non-biological disease-modifying antirheumatic drugs (DMARDs) before changing to biological therapy.

Methods A retrospective cohort study that collected information about the start of antirheumatic treatment in patients of all ages with a diagnosis of RA until the change to biological DMARD therapy. Survival analysis using Kaplan–Meier curves, from 1 January 2007 until 31 December 2013 by SPSS 23.0 for Windows, was made.

Results A total of 3880 patients (75.3% women) with a mean age of 51.3 years started non-biological DMARDs. After 5 years, 234 patients (6.0%) initiated biological DMARD therapy in 17.5±13.9 months. Differences in the socio demographic and pharmacological characteristics between the two groups of treatment are shown in the table 1. The use of glucocorticoids was associated with a greater risk of biological DMARD initiation (OR: 2.49; 95% CI: 1.658–3.732; p<0.001), while the use of methotrexate (OR: 0.04; 95% CI: 0.014–0.108; p<0.001) and chloroquine (OR: 0.13; 95% CI: 0.092–0.187; p<0.001) reduced the risk of initiation.

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Conclusions After 5 years of non-biological DMARD therapy, 6.0% of people with RA started biological DMARDs. Receiving glucocorticoids, having any comedication, being treated in Bogota City or cities of the Colombian Atlantic coast affected the probability of switching to biological therapy in these patients.

References

1. Nam JL, Emery P. Is there a place for initial treatment with biological DMARDs in the early phase of RA? Best Pract Res Clin Rheumatol. 2013;27(4):537–54.

2. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372(9636):375–82.

3. Tak PP, Rigby WF, Rubbert-Roth A, Peterfy CG, van Vollenhoven RF, Stohl W, et al. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. Ann Rheum Dis. 2011;70(1):39–46.

References

Acknowledgements To Universidad Tecnolόgica de Pereira and Audifarma S.A.

Disclosure of Interest None declared