Effectiveness of treatment with biologic- and disease-modifying antirheumatic drugs in rheumatoid arthritis patients in Colombia

Abstract

Summary Aims Rheumatoid arthritis (RA) is an autoimmune disease cause of disability and high costs. To determine the effectiveness of therapy with biologic‐ and disease‐modifying antirheumatic drugs (DMARDs) in patients with RA and factors associated with the control of the disease. Methods Retrospective cohort study of RA patients receiving treatment with DMARDs in a rheumatologic healthcare institution in five Colombian cities from December 2009 to August 2013. The effectiveness was assessed by Disease Activity Score‐28 (DAS‐28) and a lower value of 2.6 was considered remission. Results A total of 827 patients were studied for an average observation period of 17.3 ± 11.0 months, with mean age 54.3 ± 13.1 years. The most frequently used DMARDs were methotrexate, leflunomide and chloroquine. The most frequently used biological DMARDs were etanercept and abatacept. Initially, 17.8% of the patients received some biological DMARDs in comparison with 28.7% at the end of the observation period. A median DAS28 of 3.5 was found, which was reduced by the end of the observation period to 2.8 (p < 0.001), and cases of patients who were in remission increased from 30.1% to 42.9%. Treatment with leflunomide (OR: 0.47; CI 95%: 0.35–0.64, p < 0.001) or rituximab (OR: 0.37; CI 95%: 0.17–0.83, p = 0.016) was associated with a lesser probability of reaching remission. To be treated in the city of Manizales (OR: 2.56; CI 95%: 1.36–4.82, p = 0.004) was associated with a high probability of remission. Conclusions Biological and DMARDs therapy for RA was effective in a relevant proportion of Colombian patients as a consequence of management with strategies set on remission aims quantified using DAS28. Cost‐effectiveness of the therapy must be evaluated.

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

“…The patients included had a mean history of 10 years with RA, and almost half of them already had associated complications, which can be explained by the inclusion criteria, leading to a population who already had greater activity of the pathology. This made them candidates to receive bDMARDs or tofacitinib, in accordance with their high DAS28 score [5,30]. The start of the observation period of each subject was the time of first prescription of these drugs, and thus the level of activity and complications should be correlated with the therapy they had been receiving previously.…”

“…Disease-modifying antirheumatic drugs (DMARDs) are available for pharmacological treatment [3][4][5][6]. They have been classified according to their origin as biological (bDMARD) and conventional (cDMARD).…”

“…The inteleukin-6 inhibitors such as tocilizumab and the interleukin-1 inhibitors such as anakinra have similar effects, as do anti-CD-20 antibodies (rituximab) and cytotoxic T lymphocyte-associated antigen 4 blockers (abatacept). Also available is tofacitinib, which is classified as a targeted synthetic DMARD (tsDMARD) and oral therapy that specifically inhibits Janus kinases to block the activation of signal transduction pathways induced by cytokines [1,5,[10][11][12][13].…”

“…In cohorts of Colombian patients, these therapies can be highly effective, leading to remission of their disease, despite adverse reactions and costs [5,14]. Therefore, it is important to know in greater depth the factors that can influence access to and costs of healthcare for those patients who use DMARDs.…”

AB0402 Rituximab may delay the movement of rheumatoid arthritis patients on cardiorenal continuum: results from a prospective observational single-centre cohort study

“…1 Izhevsk State Medical Academy; 2 Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk, Russian FederationBackground: Similarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum. 1 CVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients 2,3. Objectives: We aimed to evaluate the effects of rituximab biologic therapy on cardiorenal continuum of RA patients.…”