Background/Purpose: Adherence and persistence to treatment are a cornerstone of treatment success in chronic diseases such as rheumatoid arthritis (RA). The purpose of this study was to describe biologic treatment discontinuation and assess the predictors of discontinuation in RA patients followed at a Canadian clinic.

Methods: In this prospective cohort study, adult patients included in the RHUMADATA computerized database with a diagnosis of RA and treated with at least one biologic agent since 2003 were selected. The RHUMADATA database includes clinical, laboratory and socioeconomic information of patients with rheumatic diseases followed at the Institut de Rhumatologie de Montréal, a rheumatology clinic in Montreal (Quebec, Canada). Patients were followed for three years after therapy initiation or until treatment discontinuation. Biologic therapies considered include abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, and anakinra. Treatment discontinuation was measured using pharmacy records. Time to discontinuation and predictors of treatment discontinuation were explored using Cox proportional hazards models.

Results: A total of 623 eligible patients were treated with at least one biologic. The average age was 53.2 years (SD=12.4), 77% were women and patients had been diagnosed for an average of 7.7 years. The average time on treatment for the first biologic agent was 1.7 years (SD=2.1). In all, 233 (37%), 326 (52%), 405 (65%), and 438 (70%) patients had stopped their first biologic treatment after 6, 12, 24, and 36 months, respectively. In time-to-event analyses (Cox proportional hazard models), type of work [part time vs. full time; hazard ratio (HR): 1.57; 95% confidence interval (CI): 1.05-2.34] and income [$20,000 to $40,000 vs. less than $20,000 (HR: 1.35; 1.01-1.80) and $80,000 to $100,000 vs. less than $20,000 (HR: 2.16; 1.23-3.80)] were significantly associated with biologic discontinuation over the complete treatment duration. The number of disease-modifying antirheumatic drugs (DMARDs) used (HR: 0.89; 0.80-0.99) and the use of methotrexate (yes vs. no; HR: 0.80; 0.64-0.99) were associated with a reduced risk of biologic discontinuation.

Conclusion: In this real-life Canadian study, high biologic discontinuation rates were observed over three years. This study also suggests that many clinical and socioeconomic variables are predictors of biologic therapy discontinuation in RA patients. These results may help design interventions aiming at improving treatment adherence in RA, a chronic and progressive disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-discontinuation-in-rheumatoid-arthritis-experience-from-a-canadian-clinic/