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Persistent moderate disease activity promotes poor outcomes in RA patients on biologics

Publish date:: October 19, 2020

Key clinical point: Rheumatoid arthritis (RA) patients with persistent moderate disease activity (pMDA) over 5 years may have a functional status trajectory that is significantly worse than patients with a persistently lower inflammatory burden.

Major finding: Among RA patients treated with biologic disease-modifying antirheumatic drugs, 23% met criteria for remission or persistently low disease activity and 77% showed pMDA after 5 years of treatment. Male gender, lower 28-joint Disease Activity Score at baseline, and improved functionality were associated with having a persistently lower inflammatory burden, and these patients also had significantly fewer serious adverse events, compared with the pMDA group (5-year mean of 0.2 vs. 0.5, P = 0.006).

Study details: The data come from a longitudinal study of 295 adults with persistent moderate disease activity and 90 with persistent lower inflammatory burden.

Disclosures: The study was supported by the Hellenic Foundation for Research and Innovation and the General Secretariat for Research and Technology. The researchers had no financial conflicts to disclose.

Commentary

“The goal of the treat to target strategy in RA is to improve patients’ short-term disease activity and long-term quality of life by maintaining a remission or low disease activity state. Despite advances in therapy, many RA patients remain in a persistent moderate disease activity state (pMDA). In this study, the long-term outcomes of 385 RA patients from the Registry of Biologic Therapies are examined; 295 patients in pMDA and 90 patients in remission or low disease activity (based on DAS28) were evaluated over 5 years of followup. Not surprisingly, patients in pMDA had worse functional outcomes over the long term; this may be affected by the overlap with patient global assessment with HAQ. The pMDA group also had more serious adverse events. The authors identified male gender and a better initial response to therapy (change in DAS28 and HAQ) as predictors of being in persistent low disease activity or remission, further underscoring the importance of early success in RA therapy, and perhaps more aggressive early therapy.”