medwireNews: The likelihood of patients with rheumatoid arthritis (RA) being refractory to multiple biologic (b)DMARDs increases if they are younger, have established joint damage when starting treatment, and do not have an early clinical response to their first biologic.
“Hence, patients with these characteristics should be monitored more closely and may benefit from personalized treatments,” write Marta Novella-Navarro (Hospital Universitario La Paz, Madrid, Spain) and co-authors in Arthritis Research & Therapy.
The researchers investigated predictors of multiple bDMARD failure using data pertaining to 402 RA patients from the La Paz University Hospital RA Registry who started taking a bDMARD between 2000 and 2019. Of these participants, 10% had multirefractory RA, defined as insufficient responses to at least two bDMARDs with different modes of action or three bDMARDs of any type.
“In other cohorts, these percentages vary, and the differences are mainly attributable to heterogeneity in definition of multi-refractory patients,” emphasize Novella-Navarro et al, citing prior percentages ranging from 3% to 17%.
By contrast, 18% of the study participants achieved low disease activity or remission following their first bDMARD that lasted for at least 5 years and were therefore considered to have nonrefractory RA.
In multivariable analysis, patients who did not have a clinical response – less than a 1.2-point change in DAS-28 scores – within 6 months of initiating treatment were a significant 11.12 times more likely to have multirefractory disease than those whose did.
Also, being younger, having bone erosions, and a higher DAS-28 score at the time of starting a first bDMARD were each associated with a significantly increased risk for multirefractory disease, with corresponding odds ratios of 0.95, 3.26, and 2.29.
The researchers believe that these factors could help predict the likelihood of multiple biologic failure prior to starting bDMARDs, which “would be of great interest to clinical practice to avoid inefficient treatments, which entail significant economic burden and potential adverse events.”
They add that patients with multirefractory disease “might benefit from further studies of targeted therapies in order to develop a tailored therapy reducing treatment failure.”
But they explain that “a universal standard definition of multi-refractoriness is needed if further studies are going to be capable of establishing predictors to multiple bDMARD failure.”
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