A Canadian study on rheumatoid arthritis (RA) revealed the influence of clinical and socioeconomic variables in the discontinuation of biologic therapy by RA patients. The study entitled “Biologic Discontinuation in Rheumatoid Arthritis: Experience from a Canadian Clinic” was presented during the College of Rheumatology Annual Meeting held last November, 14-19, in Boston, by Denis Choquette from Rheumatology, Institut de rhumatologie de Montréal (IRM), Montréal, QC, Canada, and colleagues.
Rheumatoid arthritis is an autoimmune, inflammatory and debilitating disease that leads to joint damage and higher risk for cardiovascular disease. It affects approximately 1% of adults in western countries, mainly women. In chronic diseases such as rheumatoid arthritis the adherence and permanence of treatment is fundamental to its success.
In this study, the research team characterized the discontinuation of the biologic treatment and evaluated the factors that influence treatment interruption in RA patients from a Canadian clinical center. This was a prospective cohort study, with adult individuals diagnosed with RA included in a computerized database, RHUMADATA, and subjected since 2003 to treatment with at least one biologic agent. The RHUMADATA database contained clinical, laboratory and socioeconomic information of patients with rheumatic diseases followed at the Institut de Rhumatologie de Montréal, a rheumatology clinic in Montreal (Quebec, Canada) for 3 years after therapy initiation, or until the discontinuation of treatment. The biologic therapies used for the treatment of RA patients included abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, and anakinra. The dates of treatment interruption were assessed through pharmacy reports. The Cox proportional hazards models were used to assess the length of time leading to discontinuation and factors that influenced the discontinuation of treatment.
The research team found that 623 RA patients were treated with at least one biologic. On average, the patients had an age of 53.2 years, were mainly women (77%), have been battling the disease for an average of 7.7 years, and the time after starting treatment with the first biologic drug was 1.7 years. The patients showed different times for discontinuation of treatment, 37%, 52%, 65%, and 70% of patients interrupted their first biologic treatment, respectively, after 6, 12, 24, and 36 months. Using analyses of time-to-event analyses, type of work (part time vs. full time) and salary ($20,000 to $40,000 vs. less than $20,000, and $80,000 to $100,000 vs. less than $20,000) were considerably linked with biologic interruption during the duration of the treatment. The number of disease-modifying antirheumatic drugs (DMARDs) usage and therapy with methotrexate were related with a lower risk of biologic interruption.
The researchers concluded that over a period of 3 years, there was a high level of biologic discontinuation. This study underscores the importance of several clinical and socioeconomic factors as predictors of the discontinuation of biologic therapy in rheumatoid arthritis patients. These findings are relevant for the implementation of measures to increase treatment adherence and persistence in RA.