Background/Purpose: Treatment of Rheumatoid Arthritis (RA) has undergone a big change in the last two decades in strategies, objectives and therapeutic options, especially with the use of the Disease Modifying Drugs (DMARDs), both synthetic and biological. We have little information about the management of these drugs in real life conditions so it is necessary to expand our knowledge about discontinuations and their reasons. Purpose: to describe the discontinuations of DMARDs as well as their causes in patients with incident RA.

Methods: We conducted an observational longitudinal study. Patients: all recent onset RA diagnosed between January 1^st 2007 and December 31^st 2015 followed in outpatient clinic at Hospital Clínico San Carlos until January 1^st 2017, which used any DMARD (synthetic and biologic) during at least 3 months. Primary outcome: discontinuation of the DMARD and cause of discontinuation (adverse event, inefficacy, patient decision, remission, doctor decision, others). Covariables: sociodemographic, clinical and treatment. Incidence rates of discontinuation (IR) per 100 patient-years were estimated using survival techniques with their respective 95% confidence interval [CI].

Results: We included 2388 courses of DMARD treatment in 814 patients (3706.14 patient-years). 77.52% were women with a mean age at diagnosis of 57.53±15.50 years. 72.85% of patients were diagnosed at first visit. From the courses of DMARD, 13.74% were biologicals (72.04% anti-TNF) and 60% were used in monotherapy. 55% of patients were RF positive, 44% ACPA positive and the mean DAS28 was 5.26±1.4. The most commonly prescribed drugs were Methotrexate (MTX) and Antimalarials (AM) among csDMARDs, and Etanercept (ETN) and Adalimumab (ADA) among bDMARDs. There were 1094 DMARDs discontinuations of the 2388 courses (45.81%) in 438 patients with an IR of 29.5[27.8-31.3]. 52% were due to adverse event (IR:15.95), 13.5% to inefficacy (IR: 3.99), 11.6% to doctor decision, 11.2% to patient decision, 5.8% to remission and 5.2% due to other causes. IR was higher in combined therapies, especially in triple therapy (IR: 78.19). It was higher in biologic therapy (IR: 48.8) compared to classical DMARDs. Regarding specific drugs, MTX had the lowest crude incidence (IR: 13.38). All IRs by variables are shown in table 1.

Conclusion: Global discontinuation rate was estimated in 29*patient-years, with 53.8% of treatments discontinued during follow-up. The major cause of suspension was adverse event appearance, followed by inefficacy. It seems that discontinuations are more common in combined therapies (especially in triple therapy) and in therapies including biologic drugs. Methotrexate was the most frequently prescribed drug and also the one with the lowest incidence rate of discontinuations.

DISCONTINUATIONS

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/discontinuation-of-disease-modifying-drugs-in-patients-with-incident-rheumatoid-arthritis/