RESEARCH - Do changes in prescription practice in patients with RA treated with biologics affect treatment response and adherence to therapy?

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Ann Rheum Dis. 2008 Feb 13 [Epub ahead of print]

Do changes in prescription practice in patients with rheumatoid

arthritis treated with biologics affect treatment response and

adherence to therapy? Results from the nationwide Danish Danbio

Registry.

Hetland ML, Lindegaard HM, Hansen A, Pødenphant J, Unkerskov J,

Ringsdal VS, Ostergaard M, Tarp U.

Hvidovre Hospital, Denmark.

OBJECTIVE: Prescription practice of TNFalpha inhibitors has changed

towards treating patients with lower disease activity. We studied the

trend in treatment response in rheumatoid arthritis (RA) cohorts who

started TNFalpha inhibitor treatment between 2000 and 2005. METHODS:

1813 RA patients starting biologic treatment in 2000-2005 were

registered prospectively in the nationwide DANBIO registry. Baseline

disease activity and 12 months' treatment responses were determined in

cohorts based on start year (2000/2001;2002;2003;2004;2005). RESULTS:

Despite decreasing baseline disease activity from the 2000/2001 cohort

to 2005 cohort (DAS28: from 5.9 to 5.3 (p<0.0001)), the 12 months' DAS

improvement increased from 1.8 units (2000/2001 cohort) to 2.2 units

(2005 cohort), (p=0.0003). The fraction with good EULAR response

increased from 28% (2000/2001 cohort), to 50% (2005 cohort); with no

response decreased from 29% (2000/2001 cohort) to 16% (2005 cohort).

ACR20/50/70 response rates increased from 53%/31%/13% (2000/2001

cohort) to 69%/51%/30% (2005 cohort). Corrected for withdrawals,

treatment responses were lower, but patterns unchanged. One year drug

survival was: 2000/2001 cohort: 73%, 2002: 62%, 2003: 67%, 2004: 70%,

2005: 69%.

CONCLUSION: From 2000-2005, significantly improved treatment responses

to TNF inhibitors were observed in clinical practice despite

decreasing baseline disease activity levels. This lends support to the

less stringent prescription practice towards treating patients with

lower disease activity that has been observed in several countries.

PMID: 18272669

http://www.ncbi.nlm.nih.gov/pubmed/18272669

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