Objective: Prescription practice of TNFα inhibitors has changed towards treating patients with lower disease activity. We studied the trend in treatment response in rheumatoid arthritis (RA) cohorts who started TNFα inhibitor treatment between 2000 and 2005.
Methods: 1813 RA patients starting biologic treatment in 2000-2005 were registered prospectively in the nationwide DANBIO registry. Baseline disease activity and 12 months’ treatment responses were determined in cohorts based on start year (2000/2001;2002;2003;2004;2005).
Results: Despite decreasing baseline disease activity from the 2000/2001 cohort to 2005 cohort (DAS28: from 5.9 to 5.3 (p<0.0001)), the 12 months’ DAS improvement increased from 1.8 units (2000/2001 cohort) to 2.2 units (2005 cohort), (p=0.0003). The fraction with good EULAR response increased from 28% (2000/2001 cohort), to 50% (2005 cohort); with no response decreased from 29% (2000/2001 cohort) to 16% (2005 cohort). ACR20/50/70 response rates increased from 53%/31%/13% (2000/2001 cohort) to 69%/51%/30% (2005 cohort). Corrected for withdrawals, treatment responses were lower, but patterns unchanged. One year drug survival was: 2000/2001 cohort: 73%, 2002: 62%, 2003: 67%, 2004: 70%, 2005: 69%.
Conclusion: From 2000-2005, significantly improved treatment responses to TNF inhibitors were observed in clinical practice despite decreasing baseline disease activity levels. This lends support to the less stringent prescription practice towards treating patients with lower disease activity that has been observed in several countries.
- TNF alpha inhibitors
- drug efficacy
- observational study
- rheumatoid arthritis
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