Background/Purpose: Advanced therapies including bDMARDs and tofacitinib have been shown to help control disease progression in rheumatoid arthritis (RA) and reduce joint damage. The aim of our research is to better understand if certain patient types may be more suitable for specific treatment options and assess if any of these achieve significantly different outcomes in RA patients.

Methods: We used data collected as part of an online treatment survey conducted among a panel of rheumatologists between June 2014 and January 2016 in the USA. We reviewed and analysed a total of 4,044 patient forms reported by 206 physicians. Physicians were sampled to provide a mix of practice types and regions that would be representative of the universe of treaters. The record forms collected were split into 3 patient groups, group 1 = those treated with an TNF-inhibitor biologic (etanercept, adalimumab, infliximab, certolizumab pegol, golimumab), group 2 = those treated with a non-TNF biologic (abatacept, rituximab, tocilizumab) and group 3 = those treated with the JAK-inhibitor, tofacitinib. We analysed demographic data for these patients along with their current DAS, joint count, HAQ score and perceived disease severity to assess their response to therapy over time.

Results: On average, non-TNF biologic patients are older than TNF-inhibitor (TNFi) and tofacitinib patients (53.9 years old vs. 50.0 and 51.2, respectively) and more likely to be female (75%, p <0.05). In addition, they more commonly suffer from comorbid conditions (83%) particularly when compared with TNFi patients (73%). TNFi patients are significantly more likely to be on their 1^st ever biologic (86%) compared to non-TNF and tofacitinib patients (41% and 53%, respectively) and have been on their current treatment for longer on average (32 months vs. 23 for non-TNF and 11 for tofacitinib patients). TNFi patients have on average been diagnosed for the shortest amount of time (64 months vs. 72 and 84 for tofacitinib and non-TNF patients) and experienced the shortest delay between diagnosis and 1^st biologic initiation (28 months vs. 46 and 40 for tofacitinib and non-TNF patients). A significantly larger proportion of TNFi patients is considered to have mild RA (69%) vs. non-TNF and tofacitinib patients which are more likely to suffer from moderate to severe disease. TNFi patients are more frequently deemed to be in full remission (34%) and are more likely to have a DAS28 < 2.6 (54%) while non-TNF and tofacitinib are significantly more likely to have a DAS28 between 3.2 and 5.1. However, there were no significant differences in the mean DAS28 and HAQ scores reported for patients in all 3 groups and limited differences in their mean joint counts. There were significant differences in the proportion of patients that were deemed to have severe RA at diagnosis in each group (35% for non-TNF patients, 29 for tofacitinib patients and 23% for TNFi patients) and accounting for these differences in severity at diagnosis we saw reduced differences in the proportion of patients currently in remission in each treatment group. Nevertheless, TNFi and tofacitinib patients are significantly more likely to be employed full time (51% and 48%, respectively) vs. non-TNF patients (40%) while a smaller percentage of TNFi patients are unable to work due to their RA (5%) when compared to non-TNF and tofacitinib patients (both 9%).

Conclusion: While there are significant differences in the demographics and treatment flow of patients treated with TNFi, non-TNF biologic and tofacitinib, it is unclear whether treatment choices are based on specific patient profiles or treatment guidelines and non-clinical factors. In addition, while each drug group achieved a reduction in the proportion of patients with severe disease and a considerable proportion of patients with low disease activity or remission, it is unclear whether better outcomes are consistently achieved with one treatment option vs. another. Additional research is needed to better ascertain if differences in perceived outcomes are real and what factors are truly driving them.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-real-world-view-of-rheumatoid-arthritis-patients-treated-with-advanced-therapies-comparing-patient-profiles-and-outcomes/