Abstract
Background: Biological therapy is indicated in the treatment of RA (Rheumatoid Arthritis) after failure of disease-modifying anti-rheumatic drugs (DMARDS) by the ACR/EULAR recommendations. The objective of the study is to describe the characteristics of Saudi patients at the initiation of biological therapy and to evaluate clinical effectiveness of this therapy measured by the disease activity score DAS 28. Methods: This was a retrospective cohort study of RA (rheumatoid arthritis) patients in King Fahad Hospital in Jeddah, Saudi Arabia from January 2005-July 2011. Data were collected from the medical records of all RA patients on biological therapy including: demographics, disease characteristics, comorbid illnesses and DAS 28 score over a period of 1 year. Results: 139 patients were studied (mean age 46 ± 13 years), of which 118 (84%) were females; mean duration of affliction with RA was 7.2 years ranging 1-45 years. Rheumatoid factor (RF) was positive in 88 patients (63.3%) and one or more comorbidities were present in 102 patients (73.3%). First choice of biological drug was ADA (Adalimumab) 44 patients (31.7%) and RTX (Rituximab) was the 2nd frequently prescribed biological drug. Mean DAS 28 activity at baseline was in ADA 41 patients (6.10 ± 1.62), ETA (Etarnercept) 29 patients (6.64 ± 1.42) and RTX 50 patients (6.7 ± 1.32). Moderate to good EULAR response was obtained in 74%, 85.7% and 53.3% at 6 months in ADA, ETA and RTX patients respectively. Moderate to good EULAR response was obtained in 61.8%, 86.6% and 72% in ADA, ETA AND RTX patients respectively at 1 year of treatment. Therapeutic effectiveness was comparable with the response rates in published observational trials. Conclusion: Our data demonstrate daily clinical practice in management of RA. The pattern of prescription is in agreement with the ACR/EULAR recommendations for initiation of biologicals in the treatment of RA.
Highlights
The introduction of biological therapies has dramatically changed the armament of treatment of Rheumatoid arthritis (RA)
Randomized placebo-controlled trials (RCT) on Infliximab (INF) [1]-[3], Etarnercept (ETA) [4][7], Adalimumab (ADA) [8]-[10], and rituximab (RTX) [11]-[13] have all shown to be very effective at improving the symptoms and signs of RA and at preventing structural joint damage and loss of function in diseasemodifying anti-rheumatic drug (DMARD)-resistant disease
The objective of the study is to describe characteristics of Saudi RA patients at the initiation of biological DMARDs therapy and to evaluate clinical effectiveness of this therapy measured by DAS 28, in our rheumatology unit in King Fahad Hospital, Jeddah western Saudi Arabia which is a referral center from Jeddah as well as the surrounding small districts
Summary
The introduction of biological therapies has dramatically changed the armament of treatment of Rheumatoid arthritis (RA). Randomized placebo-controlled trials (RCT) on Infliximab (INF) [1]-[3], Etarnercept (ETA) [4][7], Adalimumab (ADA) [8]-[10], and rituximab (RTX) [11]-[13] have all shown to be very effective at improving the symptoms and signs of RA and at preventing structural joint damage and loss of function in diseasemodifying anti-rheumatic drug (DMARD)-resistant disease. Biological therapy is indicated in the treatment of RA (Rheumatoid Arthritis) after failure of disease-modifying anti-rheumatic drugs (DMARDS) by the ACR/EULAR recommendations. The objective of the study is to describe the characteristics of Saudi patients at the initiation of biological therapy and to evaluate clinical effectiveness of this therapy measured by the disease activity score DAS 28. Moderate to good EULAR response was obtained in 61.8%, 86.6% and 72% in ADA, ETA AND RTX patients respectively at 1 year of treatment. The pattern of prescription is in agreement with the ACR/EULAR recommendations for initiation of biologicals in the treatment of RA
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