Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis
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)...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | Arthritis Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13075-020-02354-1 |
| _version_ | 1818850292990476288 |
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| author | Marta Novella-Navarro Chamaida Plasencia Carolina Tornero Victoria Navarro-Compán José L. Cabrera-Alarcón Diana Peiteado-López Laura Nuño Irene Monjo-Henry Karen Franco-Gómez Alejandro Villalba Alejandro Balsa |
| author_facet | Marta Novella-Navarro Chamaida Plasencia Carolina Tornero Victoria Navarro-Compán José L. Cabrera-Alarcón Diana Peiteado-López Laura Nuño Irene Monjo-Henry Karen Franco-Gómez Alejandro Villalba Alejandro Balsa |
| author_sort | Marta Novella-Navarro |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T06:46:49Z |
| format | Article |
| id | doaj.art-23628a5066f5439fabf843402e0348e9 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-19T06:46:49Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-23628a5066f5439fabf843402e0348e92022-12-21T20:31:53ZengBMCArthritis Research & Therapy1478-63622020-12-012211810.1186/s13075-020-02354-1Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritisMarta Novella-Navarro0Chamaida Plasencia1Carolina Tornero2Victoria Navarro-Compán3José L. Cabrera-Alarcón4Diana Peiteado-López5Laura Nuño6Irene Monjo-Henry7Karen Franco-Gómez8Alejandro Villalba9Alejandro Balsa10Rheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazBioinformatic Unit (GENOXPHOS-group) Centro Nacional de Investigaciones Cardiovasculares (CNIC)Rheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazRheumatology Department, Hospital Universitario La PazAbstract 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.https://doi.org/10.1186/s13075-020-02354-1Rheumatoid arthritisBiological therapyRefractory disease |
| spellingShingle | Marta Novella-Navarro Chamaida Plasencia Carolina Tornero Victoria Navarro-Compán José L. Cabrera-Alarcón Diana Peiteado-López Laura Nuño Irene Monjo-Henry Karen Franco-Gómez Alejandro Villalba Alejandro Balsa Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis Arthritis Research & Therapy Rheumatoid arthritis Biological therapy Refractory disease |
| title | Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| title_full | Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| title_fullStr | Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| title_full_unstemmed | Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| title_short | Clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| title_sort | clinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis |
| topic | Rheumatoid arthritis Biological therapy Refractory disease |
| url | https://doi.org/10.1186/s13075-020-02354-1 |
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