Session Type: Abstract Session
Session Time: 3:00PM-4:30PM
Background/Purpose: For many patients with RA on targeted therapies, the chronic burden of pain leads to therapies being deemed suboptimally effective and may affect treatment decisions. Our objective was to explore the association between patient-reported pain and switching biologic/targeted synthetic (b/ts)DMARDs.
Methods: Patients in the CorEvitas RA registry who met the following criteria were included: started a b/tsDMARD as of 1/1/2012; had ≥2 routine clinical visits; and no b/tsDMARD interruption (defined as being off treatment for >2 months). The outcome of interest was time to treatment switch to a b/tsDMARD with a different MOA. The exposure of interest was time-varying patient-reported pain measured on the visual analog scale (Pain VAS: 0–100 mm): mild (0–44 mm), moderate (45–74 mm), and severe (75–100 mm). Sociodemographics, lifestyle, disease characteristics, treatment history, and patient-reported outcomes were explored as potential confounders. Disease activity was analyzed with both time-varying Clinical Disease Activity Index (CDAI) and modified (m)CDAI (minus patient global assessment and tender joint count). Descriptive statistics stratified by baseline pain category were reported. Hazard ratios (HR) and 95% confidence intervals were reported for unadjusted and adjusted Cox hazards models with cluster-robust standard errors.
Results: Among 7806 patients, 9587 b/tsDMARD starts (Table, Panel B) were included for the following pain categories: mild (n=4126; 43%), moderate (n=2976; 31%), and severe (n=2430; 25%), missing (n=55; 1%). In patients with severe pain vs mild pain (Table, Panel A), a greater proportion were smokers (23% vs 15%); obese (52% vs 40%); and there was a higher prevalence of depression (43% vs 28%) and fibromyalgia (12% vs 3%). A higher proportion with severe pain vs mild pain reported ≥2 previous bDMARDs (50% vs 38%) and use of opioids (49% vs 18%), prednisone (39% vs 26%), and anti-depressants (33% vs 20%). The unadjusted risk of switching b/tsDMARD was ~2 times higher for severe vs mild pain (HR=1.98; 1.60–2.44; Figure). The fully adjusted risk for severe vs mild pain after accounting for confounders (HR=1.37; 1.02–1.86) was similar to the model that only included time-varying CDAI as a confounder (HR=1.35; 1.08–1.69). Compared with models that incorporated only time-varying CDAI, the risk of switching for severe pain was higher when adjusting instead for only time-varying mCDAI (HR=1.51; 1.22–1.87).
Conclusion: Patients that report greater pain are more likely to switch to a b/tsDMARD of a different MOA; an observation that remained after adjusting for confounders, including time-varying disease activity. Overall, these findings suggest that persistent pain is common in RA and influences treatment decisions, particularly a switch to a different MOA. Approaches that reduce chronic pain in this population may help reduce treatment cycling.
This GSK-funded study (214024) was sponsored by CorEvitas, LLC, with editorial support by Fishawack Indicia Ltd, funded by GSK.
To cite this abstract in AMA style:Baker J, Symons J, Janak J, Pugach O, Kohl E, Yu M, Webb D, Martin A, Saurigny D, Bracher M. Pain and Treatment Switching Among Patients in the CorEvitasTM Rheumatoid Arthritis Registry [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/pain-and-treatment-switching-among-patients-in-the-corevitastm-rheumatoid-arthritis-registry/. Accessed .
« Back to ACR Convergence 2022
ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-and-treatment-switching-among-patients-in-the-corevitastm-rheumatoid-arthritis-registry/