Reasons for b/tsDMARD cessation and persistence of second line treatment in a large real world rheumatoid arthritis dataset.

Objective To provide real world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) when treating rheumatoid arthritis (RA) patients and to assess primary failure rate for first-line treatment and the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi). Methods This is a multi-centre retrospective, non-interventional study of RA patients enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARDs between 1 August 2010 and 30 June 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation. Results Data from 7740 patients were analysed; 6914 patients received first-line b/tsDMARDs. First-line treatment was stopped in 3383(49%) patients; 1263(37%) were classified primary failures. The most common reason was “lack of efficacy” (947/2656; 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560 patients) received second line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first line TNFi was for patients receiving rituximab (39 months; 95% CI 27-74). Conclusion A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARDs with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of RA patients.