Abstract
BackgroundResponse to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). MethodsPooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes. FindingsWe identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p=0.03), and EULAR good or moderate responses at 1year was much higher among ‘rapid responders’ (p<0.001). InterpretationClinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.
Highlights
The effect of disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) on disease activity is generally presented using population means (Combe et al, 2015; Gabay et al, 2015; Littlejohn et al, 2015)
The present study focused on trajectory analyses of disease activity following the initiation of ABA, using growth mixture modeling to identify subgroups with similar response patterns
This study, which is a collaboration of nine national registries, is the first to analyze trajectories of disease activity in patients with established RA
Summary
The effect of disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) on disease activity is generally presented using population means (Combe et al, 2015; Gabay et al, 2015; Littlejohn et al, 2015). Findings: We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. Interpretation: Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation
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