Management and treatment outcomes of rheumatoid arthritis in the era of biologic and targeted synthetic therapies: evaluation of 10-year data from the KURAMA cohort

Abstract

Background Advances in rheumatoid arthritis (RA) treatment, highlighted by biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs), have altered the paradigm of RA treatment in the last decade. Therefore, real-world clinical evidence is needed to understand how treatment strategies and outcomes have changed. Methods Using an observational cohort of RA from 2012 to 2021, we collected cross-sectional data of RA patients annually to analyze a trend in RA management. For patients who initiated b/tsDMRDs, we evaluated treatment outcomes between b/tsDMARDs. Mixed-effect models were applied to examine the statistical implications of changes over time in treatment outcomes with a background adjustment. Results We analyzed annual cross-sectional data from 5070 patients and longitudinal data from 1816 patients in whom b/tsDMARDs were initiated between 2012 and 2021. b/tsDMARD use increased, whereas glucocorticoid use decreased from 2012 to 2021. Disease activity and functional disability measures improved over time. The percentage of tsDMARD prescriptions considerably increased. All b/tsDMARDs showed clinical improvements in disease activity and functional disability. Statistically, TNFi showed better short-term improvements in b/tsDMARD-naïve patients, while IL6Ri demonstrated significant long-term benefits. IL6Ri had better retention rates in switched patients. After adjustment for patient characteristics, the annual change of RA disease activity and functional disability fared significantly better from 2012 to 2021. Conclusions With the development of new RA therapeutics, overall treatment outcomes advanced in the past decade.

Real-world effects of Yishen Tongbi decoction for rheumatoid arthritis: protocol for a prospective, observational, multicenter cohort study with validation against double-blind, randomized, controlled trial

“…The combined use of csDMARDs may cause bone marrow suppression and hepatorenal toxicity ( Drosos et al, 2020 ; Yates et al, 2020 ). The application of tsDMARDs in individuals with low immunity, particularly the elderly, can lead to herpes zoster infections and increased thrombotic risks ( Fujii et al, 2024 ). The high cost of bDMARDs restricts their use and may activate latent infections like tuberculosis or hepatitis, as well as increase the risk of tumor development ( Chatzidionysiou et al, 2017 ).…”

Positive and Negative Effects of Administering a Magnetic Field to Patients with Rheumatoid Arthritis (RA)

“…Some studies showed that this method may be more effective compared with other physical factors [ 19 , 20 ]. Biological drugs and targeted therapies applied today are very helpful and improve patients’ quality of life [ 21 , 22 , 23 , 24 ]. Some patients, however, are not eligible for such treatment, or they do not respond well to these types of treatment and experience pain and impairments affecting the function of the upper limb [ 25 ].Our study proposed an alternative treatment method that can potentially be administered to patients who do not respond to biological treatments and other pharmacotherapy.This could also be an option for patients referred to rehabilitation treatments and are unable to systematically use outpatient physical therapy.…”