Identifying biologic refractory disease in people with rheumatoid arthritis
Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.
Annals of the Rheumatic Diseases
Lianne Kearsley-Fleet, Rebecca Davies, Diederik De Cock, Kath D Watson, Mark Lunt, Maya H Buch, John D Isaacs, Kimme L Hyrich.
6% of patients with rheumatoid arthritis starting biologic therapy will go on to acquire biologic refractory disease.
Biologic therapies have revolutionised treatment and outcomes for rheumatoid arthritis (RA). The expanding repertoire allows the option of switching biologic if current treatment is not effective.
This analysis aims to quantify the frequency of, and identify factors associated with, biologic refractory disease.
There were 13,502 patients with RA starting first-line tumour necrosis factor inhibitor in the BSRBR-RA from 2001 to 2014. Of these, 867 (6%) were defined as biologic refractory (starting their third class of biologic); median time to third biologic class of 8 years.
Baseline clinical factors associated with biologic refractory disease included patients registered more recently, women, younger age, shorter disease duration, higher patient global assessment, higher Health Assessment Questionnaire score, current smokers, obesity and greater social deprivation.
This first national study has identified the frequency of biologic refractory disease to be at least 6% of patients who have ever received biologic. As the choice of bDMARDs increases, patients are cycling through biologic quicker.
The aetiopathogenesis of biologic refractory disease requires further investigation. Focusing resources such as nursing support on these patients may help them achieve more stable, controlled disease.
- Many patients now use biologics for the treatment of rheumatoid arthritis (RA).
- Switching biologic is increasingly more common – 21% exposed to at least three biologics.
- Biologic refractory disease occurred in 6% of this population of patients with RA starting biologic therapy.
- Clinical factors associated with biologic refractory: females, younger, shorter disease duration, worse patient global HAQ and deprivation, smokers, obesity.
Funding: This work was supported by the British Society for Rheumatology (BSR).
Competing interests MHB has received grants from Pfizer Ltd and Roche Pharmaceuticals, as well as expert advice and honoraria from Abbvie, Astra-Zeneca, BMS, Lilly, Roche, Sandoz and UCB. JDI has received research grants from Pfizer Ltd and Roche Pharmaceuticals, as well as honoraria/fees from Abbvie, Roche, Pfizer, Janssen and BMS.
Ethics approval UK North West Multicentre Research Ethics Committee (MREC 00/8/53).