Rheumatoid Arthritis Patients Resistant to Biologic Therapy, Are They Different?

Adeeba Al-Herz¹, Aqeel Ghanem², Khulood Saleh³, Adel Al-Awadhi⁴, Waleed Al-Kandari³, Eman Hasan⁵, Mohammad Hussain⁵, Ibrahim Nahar², Fatemah Abutiban⁶, Ahmad Alenizi⁶, Yaser Ali², Ali Aldei¹, Hebah Alhajeri², Sawsan Hayat², Ahmad Khadrawy³, Ammad Fazal³, Khaled Mokaddem¹, Agaz Zaman², Ghada Mazloum², Youssef Bartella¹, Sally Hamed¹, Ramia Alsouk⁶ and Ahmed Al-Saber⁷, ¹Rheumatology, Al-Amiri Hospital, Kuwait city, Kuwait, ²Rheumatology, Mubarak Al-Kabeer Hospital, Hawally, Kuwait, ³Rheumatology, Farwania Hospital, Farwania, Kuwait, ⁴Faculty of Medicine, Kuwait, Kuwait, ⁵Al-Amiri Hospital, Kuwait city, Kuwait, ⁶Rheumatology, Jahra Hospital, Jahra, Kuwait, ⁷Department of Mathematics, Kuwait Technical College, Kuwait city, Kuwait

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Biologic agents, Disease Activity, registry, rheumatoid arthritis (RA) and treatment

Session Information

Date: Sunday, November 5, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatoid arthritis (RA) may fail to respond to biologic therapy. We study patients who are resistant to different classes of biologic agents and compare their clinical and serological features to patients who are biologic respondents.

Methods: Patient from The Kuwait Registry for Rheumatic Diseases (KRRD) who satisfied the ACR classification criteria for RA from four major hospitals were studied from February 2013 through May 2017. Patients were divided into two main groups, biologic therapy resistant defined as patients previously switched from a biologic agent or who are currently not responding to biologic therapy (DAS28 > 3.2). The second group are patients who are biologic therapy respondents defined as patients who have been in remission or in low disease activity (DAS28 < 3.2) on biologics for at least three months with no previous history of any biologic resistance.

Biologic agents were then divided into anti-TNF and non-anti-TNF agents.

In addition, patients who were resistant to >3 biologics were further studied.

Results: Among 1,280 patients with RA, 318(24%) have been prescribed at least one anti-TNF agent sometime during their disease course. Among them, 194(61%) were resistant to one anti-TNF or more. 554(43%) were prescribed at least one non-anti-TNF. Among them, 313(56%) were resistant to one non-anti-TNF or more. Of the total resistant patient, 29/507(5.7%) have failed 3 or more biologics.

Comparing the anti-TNF resistant group with the anti-TNF respondents, there was a tendency toward a thyroid disease (15.5% vs 8.1%,p=0.051) and a lower serum uric acid (means=263 vs 283 µmol/L,p=0.06). Patients who were resistant to non-anti-TNFs had more females than patients who responded to non-anti-TNFs (78% vs 68.5%, p=0.012) and a lower uric acid (means=249 vs 267µmol/L, p=0.012). Comparing patients who were resistant to > 3 biologics with patients who are biologic respondents, resistant patients had more females (93.1% vs 69.4%,p=0.007), more hyperlipidemia (24.1% vs 9.5,p=0.014), more hypertension (41.4% vs 21.4%,p=0.014) and more osteoporosis (24.1 vs 10.4%,p=0.026).

Other factors such as age, age at RA diagnosis, body mass index, rheumatoid factor, anti-cyclic citrullinated peptide antibodies, ANA, extra-articular features, family history of a rheumatic disease and other co-morbidities including cardiovascular diseases were comparable between the groups.

Conclusion: RA patients resistant to biologic therapy have some features that are different from patients who are respondents. Further study of those patients may allow an early recognition aiming at a better planning of treatment and improving their outcome.

Disclosure: A. Al-Herz, None; A. Ghanem, None; K. Saleh, None; A. Al-Awadhi, None; W. Al-Kandari, None; E. Hasan, None; M. Hussain, None; I. Nahar, None; F. Abutiban, None; A. Alenizi, None; Y. Ali, None; A. Aldei, None; H. Alhajeri, None; S. Hayat, None; A. Khadrawy, None; A. Fazal, None; K. Mokaddem, None; A. Zaman, None; G. Mazloum, None; Y. Bartella, None; S. Hamed, None; R. Alsouk, None; A. Al-Saber, None.

To cite this abstract in AMA style:

Al-Herz A, Ghanem A, Saleh K, Al-Awadhi A, Al-Kandari W, Hasan E, Hussain M, Nahar I, Abutiban F, Alenizi A, Ali Y, Aldei A, Alhajeri H, Hayat S, Khadrawy A, Fazal A, Mokaddem K, Zaman A, Mazloum G, Bartella Y, Hamed S, Alsouk R, Al-Saber A. Rheumatoid Arthritis Patients Resistant to Biologic Therapy, Are They Different? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-resistant-to-biologic-therapy-are-they-different/. Accessed .

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