MADRID – Half the patients who successfully start treatment on a biological drug for rheumatoid arthritis are off it within about 2 years, even when treatment was effective and tolerable for the first 6 months, according to U.S. registry data from more than 6,000 patients.
"These findings say to me that there is a fair amount of dissatisfaction even though we have all these treatments," Dr. Vibeke Strand said at the annual European Congress of Rheumatology. "When patients start a biologic treatment, they probably have fairly high expectations, and I might suppose that some of those expectations weren’t met," said Dr. Strand, a rheumatologist and drug consultant affiliated with Stanford (Calif.) University.
Dr. Vibeke Strand
The most common reason patients dropped their biologic was lack of efficacy, cited in 36% of the discontinuations, followed by physician preference in 28%, safety in 20%, patient preference in 18%, and treatment access in 9%. (The total exceeds 100% because more than one reason could be cited.)
The strongest correlates of treatment discontinuation were higher disease activity; patient report of anxiety, depression, or both; and starting treatment during 2007-2010, compared with patients who started in 2002-2003.
The data that Dr. Strand and her associates analyzed came from a registry of U.S. rheumatoid arthritis patients kept by the CORRONA (Consortium of Rheumatology Researchers of North America) registry. During 2002-2011, 6,209 American adults with rheumatoid arthritis in the registry received at least 6 months of treatment with a tumor necrosis factor inhibitor (81% of these patients) or another biologic drug (the remaining 19%). The patients had a mean age of 58 years and had rheumatoid arthritis for a mean of 11 years. Many (43%) had not previously been treated with a biologic drug. Patients were followed in the registry for an average of about 3 years.
By 1 year after entry, a third of the patients were off the biologic drug they entered the registry on. Half were off their entry biologic after about 2 years, and during the average 3 years of follow-up 58% of the patients stopped their medication, Dr. Strand and her associates reported (Ann. Rheum. Dis. 2013;72:71). It took a median of 27 months for patients to drop a tumor necrosis factor inhibitor and a median of 21 months for them to come off another type of biologic.
Dr. Strand stressed that because patients had been receiving their biologic drug for at least 6 months to qualify for this analysis, the subsequent dropouts from treatment do not reflect an empiric search for a safe and tolerated agent.
"The guidelines call for figuring out [if a treatment works] in the first 3 months. By requiring patients to be on treatment for at least 6 months, we got away from empiric switching," Dr. Strand said in an interview. That suggests other factors make patients stop treatment. She said she plans to look for what they might be.
The CORRONA registry and related research projects are funded by a consortium of drug companies. Dr. Strand said that she is a consultant to CORRONA and a member of its advisory board.
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