We welcome challenges, and RA is no exception. It’s a complex, systemic disease. With issues related to inflammation and immune suppression, patients with RA face significant challenges on their journey toward remission: in addition to disease-related inflammation and immune suppression, they are prone to a range of obstacles outside of the traditional manifesations of RA.1-4

Gilead scientist in the lab


RA treatments have evolved over the years. So have our expectations. While many patients will achieve ACR20, over 75% of MTX-IR or TNF-IR patients may not achieve ACR70 with targeted therapies.1

Currently, response to targeted therapies generally diminishes with every subsequent line of treatment. Up to approximately 50% of patients will not respond to a second- or third-line targeted therapy.5-7

Gilead scientists shaking hands


Healthcare professionals must find a balance in treatment to maintain optimal control of the inflammation while avoiding challenges outside of the traditional manifestations of RA. For instance, infections such as pneumonia, UTIs, and skin/soft tissue infections are the top three infections among the overall patient population with RA.3,4

Patients with RA also have twice the risk of contracting a severe infection compared with the general population.3,8 They have nearly twice the risk of herpes zoster reactivations as patients without RA9 and are at 50% greater risk of cardiovascular disease mortality than the general population.10

Multi-colored pills


In addition to monitoring, communication, and following a care plan, maintaining stable treatment is key to staying in remission. Studies have shown that approximately a third of patients discontinued bDMARD treatment within 12 months.11,12,

Analysis from the Corrona RA Registry found that some common reasons for treatment discontinuation have included a lack of efficacy or safety concerns while on therapy, as well as physician and patient preferences.11,,

Helping patients stay on therapy is key to achieving optimal treatment outcomes, as is continued communication between patients and their doctors.

Meta-analysis and review of 98 studies with over 200,000 patients with RA over the age of 18.12 Studies analyzing drug survival or discontinuation of targeted therapies in registries and healthcare databases of patients with RA were included. Data based on literature review of 6 studies from TNF and non-TNF biologics and 21 studies of TNFi.
Adult patients in the US Corrona RA Registry between 2002-2011 with RA onset ≥16 years and ≥6 months of follow-up after initiation of first/subsequent bDMARD (n=6209). Patients receiving both TNFi and non-TNFi biologics were included. Treatment discontinuation was defined as first report of stopping initial therapy or initiation of new bDMARD at/between visits, using a follow-up physician questionnaire.
Reasons for discontinuation were captured for 49.2% of patients, including loss of efficacy (35.8%), physician preference (27.8%), safety (20.1%), patient preference (17.9%), and no access to treatment (9.0%).

ACR, American College of Rheumatologists; bDMARD, biologic disease-modifying antirheumatic drug; IR, intolerance or inadequate response; MTX, methotrexate; RA, rheumatoid arthritis; TNF, tumor necrosis factor; TNFi, TNF inhibitor; UTI, urinary tract infection.


References: 1. Aletaha D, Smolen JS. JAMA. 2018;320(13):1360-1372. 2. Arthritis Foundation. Accessed September 24, 2019. 3. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Arthritis Rheum. 2002;46(9):2287-2293. 4. Ravanbod H, Jazayeri J, Russell K, Carroll G. J Immunol Infect Inflam Dis. 2017;2(3):1-9. 5. Rendas-Baum R, Wallenstein GV, Koncz T, et al. Arthritis Res Ther. 2011;13(1):R25. 6. Charles-Schoeman C, Burmester G, Nash P, et al. Ann Rheum Dis. 2016;75(7):1293-1301. 7. Genovese MC, Kremer J, Zamani O, et al. N Engl J Med. 2016;374(13):1243-1252. 8. Smitten AL, Choi HK, Hochberg MC, et al. J Rheumatol. 2008;35(3):387-393. 9. Smitten AL, Choi HK, Hochberg MC, et al. Arthritis Rheum. 2007;57(8):1431-1438. 10. Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Arthritis Rheum. 2008;59(12):1690-1697. 11. Strand V, Miller P, Williams SA, Saunders K, Grant S, Kremer J. Rheumatol Ther. 2017;4(2):489-502. 12. Souto A, Maneiro JR, Gómez-Reino JJ. Rheumatology (Oxford). 2016;55(3):523-534.

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