Persistence on biologic DMARD monotherapy after achieving rheumatoid arthritis disease control on combination therapy: retrospective analysis of corrona registry data

Dimitrios A Pappas,Scott Stryker,Elaine Karis,Tamara Lesperance,Heather J Litman,Greg Kricorian,Sabrina Rebello,Winnie Hua,Neil A Accortt

doi:10.1007/s00296-020-04667-5

Abstract

Biological disease-modifying antirheumatic drugs (bDMARDs) monotherapy may enhance adherence and decrease adverse events compared to combination therapy with conventional synthetic DMARDs (csDMARDs); however, persistence with bDMARD monotherapy has not been extensively studied. We explore persistence of etanercept monotherapy and monotherapy with other tumor necrosis factor inhibitors (TNFis) among patients first achieving remission/low disease activity (LDA) while on combination therapy with csDMARDs and a TNFi. Using Corrona registry data, the percentage of patients persistent with the index TNFi (etanercept versus other TNFis) over 6 and 12 months was determined. Factors influencing persistence and treatment patterns at 6 and 12 months were examined. Among 617 eligible patients, 56% of 182 patients on etanercept and 45% of 435 patients on other TNFis persisted with monotherapy at 6 months, 46% and 33%, respectively, at 12 months. Across first-line and subsequent biologic DMARDs, etanercept persistence was greater than other TNFi persistence by 10.8% (95% CI 2.1%, 19.6%) at 6 months and 11.4% (95% CI 0.9%, 21.9%) at 12 months. Patients on other TNFis were more likely to require reintroduction of csDMARD after 6 months (45% versus 35% for etanercept). Remission was the key predictor of persistence for both etanercept and other TNFi monotherapies. This retrospective, cohort study of registry data reflecting real-world practice indicates patients who achieve remission/LDA with combination csDMARD and TNFi therapy may successfully transition to TNFi monotherapy. Patients on etanercept monotherapy experienced greater persistence and less frequent reintroduction of a csDMARD than was observed for patients on other TNFi monotherapies.

Highlights

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease affecting the synovial lining of the joints [1], with an estimated prevalence of 0.5–1.0% [2]
Of the 46,542 adult patients with RA ever enrolled in the Corrona database, 10,413 patients were on a tumor necrosis factor inhibitors (TNFis) at the time of the analysis. 8202 patients had received a TNFi as part of a combination regimen with a csDMARD
182 patients were on etanercept monotherapy and 435 patients were on monotherapy with other TNFi therapies (Fig. 1)

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease affecting the synovial lining of the joints [1], with an estimated prevalence of 0.5–1.0% [2]. There is currently no known cure for RA [1]; the current European League Against Rheumatism (EULAR), American College of Rheumatology (ACR), and Asia Pacific League of Associations for Rheumatology (APLAR) treatment guidelines all recognize the achievement of remission or low disease activity (LDA) as a realistic goal for treat-to-target strategies [5,6,7]. Guidelines recommend conventional synthetic disease-modifying agents (csDMARDs) as first-line treatment for RA [5,6,7]. For patients not achieving sufficient disease control with csDMARDs alone, the addition of biologic DMARDs (bDMARDs) is recommended [5,6,7]. The persistency of TNFi monotherapy after achieving disease control on combination therapy has not been extensively investigated

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Discussion

Conclusion