RT Journal Article SR Electronic T1 Reasons for b/tsDMARD cessation and persistence of second line treatment in a large real world rheumatoid arthritis dataset JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.190535 DO 10.3899/jrheum.190535 A1 Peter Youssef A1 Bruno Marcal A1 Peter Button A1 Matt Truman A1 Paul Bird A1 Grad Dip A1 Hedley Griffiths A1 Lynden Roberts A1 Kathleen Tymms A1 Geoff Littlejohn YR 2019 UL http://www.jrheum.org/content/early/2019/11/25/jrheum.190535.abstract AB Objective To provide real world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) when treating rheumatoid arthritis (RA) patients and to assess primary failure rate for first-line treatment and the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi). Methods This is a multi-centre retrospective, non-interventional study of RA patients enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARDs between 1 August 2010 and 30 June 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation. Results Data from 7740 patients were analysed; 6914 patients received first-line b/tsDMARDs. First-line treatment was stopped in 3383(49%) patients; 1263(37%) were classified primary failures. The most common reason was “lack of efficacy” (947/2656; 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560 patients) received second line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first line TNFi was for patients receiving rituximab (39 months; 95% CI 27-74). Conclusion A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARDs with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of RA patients.