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Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis.
Novella-Navarro, Marta; Plasencia, Chamaida; Tornero, Carolina; Navarro-Compán, Victoria; Cabrera-Alarcón, José L; Peiteado-López, Diana; Nuño, Laura; Monjo-Henry, Irene; Franco-Gómez, Karen; Villalba, Alejandro; Balsa, Alejandro.
Afiliación
  • Novella-Navarro M; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. mnovellanavarro@gmail.com.
  • Plasencia C; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Tornero C; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Navarro-Compán V; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Cabrera-Alarcón JL; Bioinformatic Unit (GENOXPHOS-group) Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
  • Peiteado-López D; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Nuño L; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Monjo-Henry I; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Franco-Gómez K; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Villalba A; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
  • Balsa A; Rheumatology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
Arthritis Res Ther ; 22(1): 284, 2020 12 09.
Article en En | MEDLINE | ID: mdl-33298140
ABSTRACT

BACKGROUND:

Biological therapies have improved the clinical course and quality of life of rheumatoid arthritis (RA) patients. Despite the availability and effectiveness of these treatments, some patients experience multiple failures to biologic disease-modifying antirheumatic drugs (bDMARDs), constituting a particular challenge to clinicians.

OBJECTIVES:

This study aims to determine the percentage of rheumatoid arthritis (RA) patients who fail to respond to subsequent bDMARDs, describe their characteristics, and identify specific baseline and early features during the first bDMARD as possible predictors of consecutive multiple bDMARD failure.

METHODS:

This is a longitudinal study involving RA patients from the prospective biological cohort drawn from the La Paz University Hospital RA Registry (RA-Paz), starting a bDMARD during the years 2000 to 2019. Patients who presented insufficient response (due to primary or secondary inefficacy) to at least three bDMARDs or two bDMARDs with different mechanism of action were considered multi-refractory (MR-patients). Patients who achieved low disease activity or remission (by DAS-28) with the first bDMARD and maintained this over a follow-up period of at least 5 years were considered non-refractory (NR-patients).

RESULTS:

A total of 41 out of 402 (10%) patients were MR-patients and 71 (18%) NR-patients. In the multivariate analysis, the presence of erosions, younger age, higher baseline DAS-28 and mostly achieving delta-DAS < 1.2 after 6 months of the first bDMARD (OR 11.12; 95% CI 3.34-26.82) were independently associated with being MR-patients to bDMARDs.

CONCLUSIONS:

In our cohort, 10% of patients with RA were observed to have multi-refractoriness to bDMARDs. This study supports the contention that younger patients with erosive disease and especially the early absence of clinical response to the first bDMARDs are predictors of multi-refractoriness to consecutive biologics. Hence, patients with these characteristics should be monitored more closely and may benefit from personalized treatments.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Artritis Reumatoide / Productos Biológicos / Antirreumáticos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Arthritis Res Ther Asunto de la revista: REUMATOLOGIA Año: 2020 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Artritis Reumatoide / Productos Biológicos / Antirreumáticos Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Arthritis Res Ther Asunto de la revista: REUMATOLOGIA Año: 2020 Tipo del documento: Article