Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry
Abstract:According to international recommendations, the selection of the biologic disease modifying anti-rheumatic drug (bDMARD) for rheumatoid arthritis (RA) is mainly left to the clinician's preference. We analyzed the real-life factors influencing the first-line choice or the switching strategy, focusing on the prescription of abatacept (ABA) or tocilizumab (TCZ) compared to TNFα inhibitors (TNFi). Patients enrolled in the Lombardy Rheumatology Network (LORHEN) Registry after January 1, 2010, when all considered bD… Show more
“…Although there is no consensus on age, infectous risk, and comorbidities that affect the choice of the biological drugs in patients with RA, switching to biological treatments apart from TNFi are also supported for most TNFi insufficient responders. [ 25 , 26 ] Our real life study demonstrated that comorbidties affect the choice of first line biological DMARDs however we couldn’t find significant differences in the choice of second line biological DMARDs and swapping to biological treatments apart from TNFi. Furthermore, there was no significant differences between the groups with or without history of orthopedic surgery regarding the choice of first line and second line biological therapy.…”
The objective of this study was to assess the frequency of comorbidities and multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and their effects on biological disease modifying antirheumatic drugs (DMARDs) choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. Cardiovascular, infectious, cancer, and other comorbidities were recorded with face to face interviews. Multimorbidity is defined as >1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choice were recorded. Disease activity score-28 (DAS-28) responses were compared to comorbidity presence and multimorbidity.Total of 998 RA patients were enrolled into the study. The mean age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. The median durations of first biological DMARDs prescription were 60 (3–552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration was longer than the duration for patients without multimorbidity (72 [3–552] vs 60 [3–396] months, P < .001). The physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less frequently than other biological DMARDs in patients with at least 1 comorbidity (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients with comorbidities and multimorbidity achieved DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P = .001, respectively).In real life, physicians may postpone to prescribe biological DMARDs and less frequently choose TNFi biological drugs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response.
“…Although there is no consensus on age, infectous risk, and comorbidities that affect the choice of the biological drugs in patients with RA, switching to biological treatments apart from TNFi are also supported for most TNFi insufficient responders. [ 25 , 26 ] Our real life study demonstrated that comorbidties affect the choice of first line biological DMARDs however we couldn’t find significant differences in the choice of second line biological DMARDs and swapping to biological treatments apart from TNFi. Furthermore, there was no significant differences between the groups with or without history of orthopedic surgery regarding the choice of first line and second line biological therapy.…”
The objective of this study was to assess the frequency of comorbidities and multimorbidities in rheumatoid arthritis (RA) patients under biologic therapy and their effects on biological disease modifying antirheumatic drugs (DMARDs) choice, timing, and response.Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. Cardiovascular, infectious, cancer, and other comorbidities were recorded with face to face interviews. Multimorbidity is defined as >1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choice were recorded. Disease activity score-28 (DAS-28) responses were compared to comorbidity presence and multimorbidity.Total of 998 RA patients were enrolled into the study. The mean age was 53.1 (12.5) and mean disease duration (standard deviation [SD]) was 11.7 (7.5) years. At least 1 comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. The median durations of first biological DMARDs prescription were 60 (3–552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration was longer than the duration for patients without multimorbidity (72 [3–552] vs 60 [3–396] months, P < .001). The physicians prescribe tumor necrosis factor inhibitor (TNFi) biological drugs less frequently than other biological DMARDs in patients with at least 1 comorbidity (66.2% vs 74.5%, P = .007) or multimorbidity (34.6% vs 43.5%, P = .006). Patients with comorbidities and multimorbidity achieved DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, P = .012 and 27.2% vs 39.7%, P = .001, respectively).In real life, physicians may postpone to prescribe biological DMARDs and less frequently choose TNFi biological drugs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response.
“…For RA patients with active disease despite conventional DMARDs, current recommendations do not specify a treatment of choice from among approved anti–tumor necrosis factor (anti‐TNF) inhibitors (e.g., adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) or the non‐TNF options (e.g., abatacept, anakinra, rituximab, sarilumab, tocilizumab, and tofacitinib) in some cases . The choice of biologic therapy for each patient is generally based on consideration of patient‐related factors, disease‐related factors, the mechanism of action of the prescribed medication, and patient preferences for treatment .A general preference for subcutaneous biologic therapies has previously been reported among rheumatology patients.Results of the current surveys indicate that rheumatoid arthritis patients, including biologic‐naive patients, are generally open to intravenous or subcutaneous treatment.Patients receiving intravenous therapy express high satisfaction with this route of administration.…”
These survey results indicate that RA patients are generally open to IV treatment and express high satisfaction with IV therapy. Additional patient and provider education may improve shared decision-making regarding biologic therapy administration options. This article is protected by copyright. All rights reserved.
“…The use of bDMARDs in controlling patients with rheumatoid arthritis has revolutionized the evolution of the disease (13). Despite the broad spectrum and the constant development of biological treatment, there is no solid proof for the strategy of choosing the rst bDMARDs.…”
Section: Discussionmentioning
confidence: 99%
“…Concerning comorbidities, arterial hypertension was more represented in TCZ group compared to non-TCZ group and the opposite for diabetes that was associated with the non-TCZ group. Monti S et al (13) revealed that age and comorbidities in uence the choice towards ABA and TCZ compared to TNFi. Previous studies indicated that age and the presence of comorbidities are associated with a decreased response by Etanercept (19,20).…”
Section: Discussionmentioning
confidence: 99%
“…In the literature, several factors have been advocated as parameters of choice of the rst bDMARDs such as comorbidities, cardiovascular risk, infectious risk, preference for a speci c route of administration, predictive biomarkers such as seropositivity for rheumatoid factor (RF) and / or anti-citrullinated protein antibodies (ACPA), the cost-effectiveness and type of health coverage (4,8,13).…”
Background: The aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment.Methods: Cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized.Results: A total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type.Conclusion: Our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.
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