RT Journal Article
SR Electronic
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
FD The Journal of Rheumatology
SP jrheum.190102
DO 10.3899/jrheum.190102
A1 Edward Keystone
A1 Emmanouil Rampakakis
A1 Mohammad Movahedi
A1 Angela Cesta
A1 Melissa Stutz
A1 John S.  Sampalis
A1 Francois Nantel
A1 Karina Maslova
A1 Claire Bombardier
YR 2019
UL http://www.jrheum.org/content/early/2019/06/24/jrheum.190102.abstract
AB 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.