Background/Purpose:

RA is a burdensome for most of the patients, comorbidities usually provide additional disadvantags the course of RA. The possible effects of comorbidities on selection of biological DMARDs in RA patients were not frequently assessed.

Objectives: The objective of this study was to assess effects of comorbidities and multimorbidities on biological DMARDs choose, timing of biological DMARDs and response of biological DMARDs.

Methods:

Hacettepe University Biologic Registry (HUR-BIO) is single center biological DMARD registry. After 2012, all known comorbidities reported by patients were evaluated by a standard questionnaire. HUR-BIO included 1235 patients with RA and 998 patients were assessed for comorbidities. Assessed comorbidities were obesity, diabetes, hypertension, hyperlipidemia, osteoporosis, coronary heart disease, cerebrovascular event, chronic kidney disease, hepatitis B, tuberculosis, amyloidosis, and cancer. Multimorbidity defined as more than 1 comorbidity. Disease duration, initial date of biological DMARDs, initial and overall biological DMARD choose were recorded. DAS-28 responses were compared to comorbidity presence and multimorbidity.

Results:

Totally, 998 RA patients were enrolled. The mean age was 53.1 (12.5) and mean disease duration (SD) was 11.7 (7.5) years. At least one comorbidity was detected in 689 (69.1%) patients, 375 (37.9%) patients had multimorbidity. Patients had mean 1.36 ± 1.32 comorbidity. Patients with comorbidity were older (56.2 ± 11.3 vs 46.1 ± 12.4, p<0.001), more frequently female (83% vs 74%, p=0.01), worst functional disability (HAQ score 1.0 (0-2.9), vs 0.77 (0-2.5), p<0.001) and highest baseline patient global assessment score (70 (0-100) vs 60 (10-100), p=0.004). The median duration of first biological DMARDs prescription were 60 (3-552) months after RA diagnosis. For multimorbidity patients, the median first biological prescription duration were longer than patients without multimorbidity patients (72 (3-552) vs 60 (3-396) months, p<0.001). The physicians prescribe anti-TNF biological drugs less frequently than other biologic DMARDs in patients with at least one comorbidity (66.2% vs 74.5%, p=0.007) or multimorbidity (34.6% vs. 43.5%, p=0.006). Patients with comorbidities and multimorbidity achieved to DAS-28 remission less frequently than patients without comorbidity (31.6% vs 42.6%, p=0.012 and 27.2% vs 39.7%, p=0.001, respectively).

Conclusion:

Physicians were postpone to prescribe biological DMARDs in patients with multimorbidity. Furthermore, comorbidity may have a negative effect on the treatment response. This situation may rise from both late start of the efficient treatment and additional burden effect of the comorbidities on the course of RA disease.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/starting-of-biological-dmards-may-be-postponed-in-ra-patients-with-multimorbidity-single-centre-real-life-results/