Background/Purpose: In the last decade, biologic medications have transformed the management of RA. The effectiveness of these medications has been reported in numerous randomized controlled trials and cohort studies. A summary of the effect size for biologic medications would be useful to inform expectations of rheumatologists and patients when considering and commencing these medications. Further, with an increased interest in real-life effectiveness data from clinical registries, comparisons between controlled trial and registry effectiveness outcomes would be of interest.

Methods: Using PRISMA methodology, a pre-specified search and review strategy was devised to answer the question “what are the EULAR response rates for biologic medications in adults with active RA?” MEDLINE and EMBASE were searched for Rheumatoid Arthritis (Both Mesh term and free text) in Title/Abstract AND Name of biologic drug (free text) in Title/Abstract OR Biologic Therapy (Mesh term) OR ‘Biologic’ (free text) in Title/Abstract AND EULAR response (free text) in Entire Document AND Adult (free text) Entire Document. All articles were reviewed independently by 2 experts; duplicates and non-primary research articles were removed along with those using medication doses outside of the approved Australian indications, and only patients with ≥ moderate DAS or tender/swollen joint count ≥ 4 were included. Whether the patients were naïve to biologic DMARD and whether the response assessment was at 3 (2.0 – 4.5) months or 6 (4.5 – 7.0) months was recorded. The percentage of patients achieving a moderate, good, or either EULAR response was calculated overall and for subgroups.

Results: Overall, 27,280 patients were included representing 62 studies. Mean baseline DAS28 was 6.0 (SD=0.6). Good (G) and moderate (M) EULAR responses were achieved in 25.8% and 47.3% respectively, with 28.1% failing to achieve a Good or Moderate EULAR response when all patients were pooled. Response rates were similar for patients who were naïve to biologics (G-24.0% & M-47.5%), those who had failed to respond to at least 1 biologic (G-28.1% & M-47.1%) and at both 3 months (G-27.1% & M-50.4%) and 6 months (G-25.2% & M- 46.3). Sufficient data was present for separate analyses of adalimumab (ADA), etanercept (ETN) and tocilizumab (TCZ) and EULAR response rates were similar, however tocilizumab had a higher rate of good EULAR response [37.4% (TCZ), 28.2% (ADA), 27.6% (ETN)].

Conclusion: A systematic review of studies reporting EULAR response rates for biologic medications in active RA showed that only 28.1% of patients fail to achieve at least a moderate EULAR response. Response rates were similar for patients who were naïve or had previous exposure to biologics, for 3 and 6 months assessment time points, and for different biologic medications. Comparison of these controlled trial data with real life response rates reported in clinical registries will be of interest.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-biologic-medications-in-active-rheumatoid-arthritis-a-systematic-review/