RESEARCH - Benefit of anti-TNF therapy in RA patients with moderate disease activity

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Rheumatology Advance Access originally published online on August 25, 2009

Rheumatology 2009 48(10):1323-1327; doi:10.1093/rheumatology/kep242

Benefit of anti-TNF therapy in rheumatoid arthritis patients with

moderate disease activity

Kimme L. Hyrich1, Deighton2, Kath D. 1, BSRBR Control

Centre Consortium1,*, Deborah P. M. Symmons1, Mark Lunt1 on behalf of

the British Society for Rheumatology Biologics Register

1ARC Epidemiology Unit, University of Manchester, Manchester and

2Department of Rheumatology, Derbyshire Royal Infirmary, Derby, UK.

Abstract

Objectives. Anti-TNF therapy has improved outcomes for patients with

highly active RA. Less is known about its effectiveness in patients

with lower disease activity. The aim of this analysis is to compare

the response to anti-TNF therapy between RA patients with high (DAS28

> 5.1) and moderate (DAS28 > 3.2–5.1) disease activity.

Methods. A total of 4687 anti-TNF and 344 DMARD patients with high

disease activity despite treatment with two standard DMARDs (including

MTX) and 224 anti-TNF- and 300 DMARD-treated patients with moderate

disease activity were selected from the British Society For

Rheumatology Biologics Register. Mean change in HAQ over the first 12

months of enrolment was compared first between anti-TNF-treated and

untreated patients in each DAS28 group, and then between

anti-TNF-treated patients in the moderate and high DAS28 groups, using

doubly robust estimates, adjusting for age, gender, disease duration,

baseline HAQ and DAS28 score, number of previous DMARDs and steroid

use.

Results. Compared with anti-TNF-untreated patients within each DAS

group, treated patients were younger, had higher DAS28 and HAQ and had

failed a higher number of previous DMARDs. The mean adjusted change in

HAQ over 12 months was similar in anti-TNF-treated patients with

moderate and high disease activity at baseline: moderate –0.26 (95% CI

–0.35, –0.16), high –0.28 (95% CI –0.34, –0.23) and mean difference

–0.03 (95% CI –0.14, 0.08).

Conclusions. Improvement in HAQ score 12 months after start of

anti-TNF therapy was not dependent on baseline DAS28 scores,

suggesting that substantial benefits may also be gained by treating

those with moderately active disease despite standard DMARD therapy.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/10/1323?etoc

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