Background/Purpose:

The aim of our study is to understand whether the use of biologic monotherapy among rheumatoid arthritis (RA) patients is increasing and whether this has any impact on their potential outcomes when compared to combination therapy with traditional disease-modifying antirheumatic drugs (DMARDs).

Methods: We used data collected as part of an online treatment survey conducted among a panel of rheumatologists between May 2008 and December 2012 across the five largest EU countries (France, Germany, Italy, Spain and the UK). We selected a sub-sample of  43,193 patient records from this data set. Patient cases were selected if a patient was currently prescribed his or her first ever biologic. This limited any confounding effects due to patients’ previous biologic experience. No other screening criteria or quotas were applied to the data to ensure a natural fall-out of monotherapy patients. Patient demographics and key indicators of current health and quality of life were analysed including: disease activity score (DAS), overall joint count, perceived disease severity at diagnosis and latest consultation (assessed by physician), ability to work and current co-morbidities.

Results:

In Q4 2012, 24% of reported biologic patients were currently treated without the concomitant use of traditional DMARDs, a non-significant increase over the level observed in Q2 2008 (23%).  The use of biologic monotherapy was most common for patients treated with tocilizumab (42%) and was most frequently seen among our Italian and UK patients (26%). Monotherapy patients were on average significantly older (> 60 years old) and were perceived to have milder disease at diagnosis when compared to patients simultaneously treated with biologics and DMARDs. In addition, monotherapy patients were significantly more likely to have inflammatory back pain, ankylosing spondylitis, congestive heart failure and wider cardiovascular disease, whereas fibromyalgia and dactylitis were more common in patients receiving combination therapy. There were no differences in patients’ gender, time since diagnosis and ability to work or the number of DMARDs patients had tried prior to initiating their biologic. However, when adjusting for disease severity at diagnosis, we saw no difference in physicians’ perceptions of the current disease severity of patients from both groups, although a significantly higher proportion of monotherapy patients had a DAS < 2.6 (51%) while a significantly greater proportion of combination therapy patients has a DAS > 5.1 (7%).

Conclusion:

Our data show that the use of biologic monotherapy has remained steady over the last four years and has been concentrated primarily among tocilizumab patients. Biologic monotherapy appears to be reserved for older, potentially more fragile patients with milder disease whereas combination therapy may still be preferred for patients with more severe forms of RA. Moreover, use of biologic monotherapy does not seem to negatively impact on patient outcomes with a significantly higher proportion of these patients achieving disease remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-evolving-use-of-biologic-monotherapy-in-rheumatoid-arthritis-and-its-impact-on-patient-outcomes/