Effectiveness of biologics in Australian patients with rheumatoid arthritis: a large observational study: REAL

AIMS: To assess the effectiveness of biologic disease-modifying anti-rheumatic drugs (bDMARDs) as monotherapy or in combination with methotrexate and/or other conventional DMARDs (cDMARDs) for treatment of rheumatoid arthritis (RA). METHODS: A retrospective, non-interventional study which investigated the use of bDMARDs in adult patients with RA in routine clinical practice. Data was extracted from the OPAL-QUMI database. Real-world effectiveness was measured using the 28-joint disease activity score (DAS28) and clinical disease activity index (CDAI) by treatment group at baseline, week 12 and week 24. RESULTS: 2,970 patients were included with median (min-max) age of 60.0 (19.0-94.0) years and median (min-max) duration of RA before first bDMARD treatment of 6.0 (0.2-58.3) years. A total of 1,177 patients received more than one bDMARD during the analysis period 1 January 1997 to 15 August 2015. Patients had 4,922 treatment "episodes" (defined as a cycle of continuous individual bDMARD prescribing in a single patient). Patients received a mean (SD) of 1.7 (1.0) episodes of treatment with median (min-max) treatment duration 0.7 (0-11.8) years; median treatment duration was higher with the first treatment episode. bDMARDs were most commonly initiated in combination with methotrexate (73.9% of episodes) and least commonly as monotherapy (9.9% of episodes). Median (min-max) baseline DAS28 decreased from 5.3 (0-8.7) with the first bDMARD to 3.7 (0-8.8) with the second. Median baseline CDAI similarly decreased. CONCLUSIONS: Patients tended to persist longer on their first bDMARD treatment. bDMARDs as monotherapy or in combination appear to be accepted treatment strategies in the real world. This article is protected by copyright. All rights reserved.