Background There are limited literature data regarding the characteristics of rheumatoid arthritis (RA) patients treated with biologic DMARD (bDMARD) monotherapy.
Objectives To evaluate the disease and treatment characteristics of RA patients treated with bDMARD monotherapy.
Methods Multicenter, cross-sectional RA epidemiological study in Greece (06/2015–05/2016, ERE RA Study Group). Demographics, disease characteristics, treatment and co-morbidity data were collected via a web-based platform
Results 1036 RA patients treated with bDMARDs were identified during the one year recruitment period (female: 82%, mean age: 61.5±13 years, mean disease duration: 12.5±8.9 years, mean DAS28-ESR: 3.4±3.3). Among them, 26% (n=273) were receiving bDMARDs as monotherapy and 8% (n=23) of them had never tried conventional synthetic DMARDs (csDMARDs) before; The latter group (n=23) compared to the csDMARD-exposed (92%, n=250) group, had more often co-morbidities [cardiovascular disease (22% vs. 8%, p=0.029), chronic hepatitis (13% vs. 3%, p=0.02), hypertension (57% vs. 38%, p=0.08), COPD (13% vs. 4.4%, p=0.07)] or were active smokers (41% vs. 14%, p=0.001). csDMARD discontinuation was mainly due to adverse events (AEs, 58%) followed by inadequate response (IR, 44%). Compared to the cs- and b-DMARD combination therapy group, monotherapy treated patients were more frequently seropositive (64% vs. 57%, p=0.003), had lower DAS28-ESR (3.2 vs 3.5, p=0.009) and were more likely to have discontinued csDMARDs for AEs (58% vs. 21%, p<0.001) or IR (44% vs. 27%, p<0.001). Tocilizumab (22.3% vs. 12.7%, p<0.001) and rituximab (19.8% vs. 13.5%, p=0.013) were utilized more often, whereas adalimumab less often (8.8% vs. 14.8%, p=0.012) as monotherapy compared to as part of combination therapy.
Conclusions In our large RA cohort, one out of four bDMARD treated patients, were receiving bDMARDs as monotherapy. Co-morbidities rather than RA characteristics influence the initial decision for bDMARD monotherapy whereas among those starting combination cs- and b-DMARD therapy, the majority discontinue csDMARDs due to AEs.
Acknowledgements Grant support from the Hellenic Rheumatology Society and Professional Association of Rheumatologists.
Disclosure of Interest None declared