Comparative Effectiveness of Nonbiologic versus Biologic Disease-modifying Antirheumatic Drugs for Rheumatoid Arthritis

DeWitt, Esi Morgan; Li, Yanhong; Curtis, Jeffrey R.; Glick, Henry A.; Greenberg, Jeffrey D.; Anstrom, Kevin J.; Kremer, Joel M.; Reed, George W.; Reed, Shelby D.

doi:10.3899/jrheum.120400

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Propensity scoring also reduces the statistical power of an analysis, as shown in a Corrona study comparing csDMARDs and biologics. 29 Also, we used the inverse probability treatment weighting method to create weights based on the propensity score. Since we did not use propensity score matching to create two comparable monotherapy and combination therapy groups, we cannot provide a comparison of matched monotherapy vs combination therapy cohorts in order to evaluate how well other covariates are balanced.…”

Section: Discussionmentioning

confidence: 99%

“…To control for channelling bias, all patients receiving monotherapy or combination therapy were matched using a propensity score matching method. 28 29 The propensity score was estimated using CDAI and patient sex. These variables were chosen following an analysis of the data using other possible risk factors (swollen and tender joint counts, CDAI, physician global assessment of disease activity, history of csDMARD use and history of MTX use).…”

Section: Methodsmentioning

confidence: 99%

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Comparative effectiveness of biologic monotherapy versus combination therapy for patients with psoriatic arthritis: results from the Corrona registry

Mease

Collier

Saunders³

et al. 2015

RMD Open

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ObjectivesTo characterise the comparative effectiveness of combination therapy (a tumour necrosis factor inhibitor (TNFi) and a conventional synthetic disease-modifying antirheumatic drug (csDMARD) such as methotrexate) and monotherapy (TNFi only) for psoriatic arthritis (PsA) from a large US registry.MethodsThe analysis included adult patients with PsA who were enrolled in the Corrona database (ClinicalTrials.gov, NCT01402661), had initiated a TNFi, were biologic naïve, and had a follow-up visit ≥90 days after drug initiation. The endpoints of the analysis were TNFi persistence (drug survival) and time to Clinical Disease Activity Index (CDAI) remission. All analyses were performed using propensity scoring, which were estimated using CDAI and patient sex, to control for channelling bias.ResultsOf 519 patients meeting the inclusion criteria (318 with combination therapy and 201 with monotherapy), the analysis population was 497 for TNFi persistence and 380 for time to remission. The difference between combination therapy (TNFi+methotrexate, 91% of patients; TNFi+other csDMARD, 9%) and monotherapy was not statistically significant for TNFi persistence (32 and 31 months, p=0.73) and time to remission (21 and 25 months, p=0.56). Predictors of TNFi persistence included Hispanic ethnicity (longer persistence), PsA duration (longer persistence), history of methotrexate use (shorter persistence), body mass index (shorter persistence) and disease activity (shorter persistence).ConclusionsPatients with PsA from a large US registry experienced similar TNFi persistence on combination therapy and monotherapy. Prospective, randomised clinical trials evaluating the efficacy of combination therapy versus monotherapy would provide much-needed clarity on treatment options for patients with PsA.Trial registration numberNCT01402661.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparative effectiveness of biologic monotherapy versus combination therapy for patients with psoriatic arthritis: results from the Corrona registry

Mease

Collier

Saunders³

et al. 2015

RMD Open

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“…Registry study data can be used to examine whether longer-term exposure to a biologic maintains the benefits for reduced disease activity and function impairment. Previous analyses of registry data have shown that RA patients who respond to biologic therapy in the first 6-12 months usually experience persistent benefits if they continue biologic therapy for several years [15][16][17][18][19][20][21][22][23][24]. The objective of this analysis was to examine the effect of cumulative exposure to biologics on patient outcomes over time, as well as predictors for improvement in outcomes.…”

Section: Introductionmentioning

confidence: 99%

The longitudinal effect of biologic use on patient outcomes (disease activity, function, and disease severity) within a rheumatoid arthritis registry

et al. 2019

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Introduction Biologics effectively manage symptoms and disease activity in rheumatoid arthritis (RA), but their long-term effects remain unclear. Method Longitudinal data were examined from the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registry. Linear regression modeled the effect of biologic exposure on changes in disease activity (Disease Activity Score-28 with C-reactive protein [DAS28-CRP]), functional status (modified Health Assessment Questionnaire [mHAQ]), and RA severity (Routine Assessment of Patient Index Data [RAPID3]). Biologic exposure was the ratio of time on a biologic relative to time participating in the BRASS cohort. Results The analysis included 1395 RA patients, 82.3% female, with 6783 unique study visits from 2003 to 2015. At the patient's first visit, mean (SD) age was 56.3 (14.2) years and mean (SD) duration of RA was 12.7 (11.9) years. Average follow-up duration was 5.59 years (range, 1-13). Over time, DAS28-CRP, mHAQ, and RAPID3 scores decreased as the biologic exposure ratio increased. In repeated measures regression models, increased biologic exposure was significantly associated with decreased DAS28-CRP score (β = − 0.647; P < 0.001), decreased mHAQ score (β = − 0.096; P < 0.001), and decreased RAPID3 score (β = − 0.724; P < 0.001) during follow-up. Methotrexate use at baseline predicted decreased DAS28-CRP, mHAQ, and RAPID3 scores during follow-up. Biologic use at baseline predicted increased DAS28-CRP or mHAQ during follow-up. Conclusions Increased biologic exposure is associated with decreased disease activity, function impairment, and RA severity. Future studies should examine whether earlier initiation of biologics improves patient outcomes in RA. Trial Registration ClinicalTrials.gov, NCT01793103 Key Points• Biologics effectively manage symptoms and disease activity in rheumatoid arthritis (RA), but their long-term effects remain unclear.Clinical Rheumatology (2019) 38:3081-3092 / Published online: 2019 uly J 29• In this analysis of longitudinal annual population samples of 1395 RA patients in the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registry, disease activity, function, and severity scores improved as time on biologic therapy increased.• In repeated measures regression models, time on biologic therapy was a significant predictor of improved outcomes for disease activity, function, and RA severity.• Further studies should examine whether earlier initiation of biologics limits the long-term effect of inflammation on RA outcomes.

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“…compared the biological and nonbiological drugs in RA patients and found that biological drugs combined with Methotrexate exerted an effect similar to nonbiological drugs used as triple therapy. [9] Another study carried out in the Netherlands compared the effect of biological drugs and DMARDs on RA patients for 2 years. The results indicated that recovery was faster in the group that received biological drugs plus Methotrexate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Disease: Modifying Antirheumatic Drugs Alone or in Combination with Biologic Drugs in the Outcome of Patients with Rheumatoid Arthritis

et al. 2019

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Background: Rheumatoid arthritis (RA) is a rheumatic disease that could be disabling if not treated. The aim of RA therapy is to resolve tenderness and swelling in the joints. The present study was conducted to compare two methods of RA treatment with disease-modifying anti-rheumatic drugs (DMARDs) and DMARDs with biologic drugs in two groups of patients. Materials and Methods: The present study was a nonrandomized clinical trial which was conducted from July to September 2017 on 110 patients who were selected based on the American College of Rheumatology (2010) criteria for RA. Patients were divided into two groups of 55: Groups A and B. For the treatment of Group A, prednisolone along with one or two drugs from the DMARDs combinations was used. Group B received one biologic drug besides with the drugs of the group A. T -test and covariance analysis was used to compare the outcomes of both groups. Results: Disease activity score (DAS-28) at the beginning of the study was 4.23 (0.81) in Group A and 4.51 (0.7) in Group B ( P = 0.05). At the end of the study, DAS-28 was 3.52 (0.79) in Group A and 3.75 (0.85) in Group B ( P = 0.1). DAS-28 activity index had a significant difference between both two groups at the beginning of the study ( P = 0.05), but at the end of the study, the difference was not statistically significant ( P = 0.1). Conclusions: Simultaneous use of DMARDs and biologic drugs in RA patients could lead to improvement the disease symptoms and decrease the severity and activity of the disease.

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Comparative Effectiveness of Nonbiologic versus Biologic Disease-modifying Antirheumatic Drugs for Rheumatoid Arthritis

Cited by 6 publications

References 22 publications

Comparative effectiveness of biologic monotherapy versus combination therapy for patients with psoriatic arthritis: results from the Corrona registry

Comparative effectiveness of biologic monotherapy versus combination therapy for patients with psoriatic arthritis: results from the Corrona registry

The longitudinal effect of biologic use on patient outcomes (disease activity, function, and disease severity) within a rheumatoid arthritis registry

Comparison of the Effect of Disease: Modifying Antirheumatic Drugs Alone or in Combination with Biologic Drugs in the Outcome of Patients with Rheumatoid Arthritis

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