TY - JOUR T1 - Towards Defining Primary and Secondary Non-Response in Rheumatoid Arthritis Patients Treated with Anti-TNFs: Results from the BioTRAC and OBRI Registries JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.190102 SP - jrheum.190102 AU - Edward Keystone AU - Emmanouil Rampakakis AU - Mohammad Movahedi AU - Angela Cesta AU - Melissa Stutz AU - John S. Sampalis AU - Francois Nantel AU - Karina Maslova AU - Claire Bombardier Y1 - 2019/07/01 UR - http://www.jrheum.org/content/early/2019/06/24/jrheum.190102.abstract N2 - Objective Although most RA patients respond to anti-TNF treatment, some present with initial (‘1ry’) non-response or lose initial responsiveness (‘2ry’ non-response). We compared the rate of real-world ‘non-response’ to first anti-TNF as reported by treating physicians to the non-response rate per accepted definitions and recommended treat-to-target strategies. Methods Patients from the BioTRAC and OBRI registries, on their first anti-TNF, with ≥1 follow-up visit were included. Post-hoc re-classification of physician-reported ‘non-response’ was based on prior achievement of DAS28-ESR low disease activity (LDA), CDAI LDA, or good/moderate EULAR response, and actual time of physician-reported ‘non-response’. Results Among 736 BioTRAC and 640 OBRI patients, 13.7% and 18%, discontinued their anti-TNF due to physician-reported ‘non-response’. Based on re-classification using disease activity, 65.6% (BioTRAC) and 87.2% (OBRI) of ‘1ry non-responders’ did not achieve DAS28-ESR LDA, 65.6%/90.7% CDAI LDA, and 46.9%/61.5% good/moderate EULAR response. Among ‘2ry non-responders’, 50.7%/47.8% did not achieve DAS28-ESR LDA, 37.7%/52.9% CDAI LDA, and 15.9%/19.6% good/moderate EULAR response before treatment discontinuation. Regarding actual time of ‘non-response’, 18.8% of BioTRAC and 60.8% of OBRI ‘1ry non-responders’ discontinued at ≤6 months. In both registries, a high proportion of ‘2ry nonresponders’ discontinued their anti-TNF after 12 months (87.0% BioTRAC, 60.9% OBRI). Conclusion Physician-reported ‘1ry non-response’ was more correlated with non-achievement of DAS28- ESR LDA or CDAI LDA, whereas ‘2ry non-response’ with actual time of discontinuation. Further work is needed to confirm the importance of response and type of response to the initial anti-TNF in identifying patients most likely to benefit from a second biologic agent treatment. ER -