The Practical Implications
The findings can help rheumatologists with patient management decisions, according to the authors.
“Quantifying the frequency of multiple bDMARD class failure is crucial, particularly in an environment where bDMARD choice is largely based on custom and experience rather than by individual biomarkers,” the authors wrote.
Study researcher Kimme L. Hyrich, MD, PhD, from the Arthritis Research UK Centre for Epidemiology at the University of Manchester, England, had some additional thoughts. “This is an important finding [because] it allows the rheumatology community and funders the opportunity to better design services with the knowledge of the numbers of patients who will require regular clinical review,” Dr. Hyrich says. “As the choice of biologics and other related therapies increases, particularly with respect to new modes of action, it will be important for budget planning to ensure that funding for these drugs is not rejected based solely on the number of biologics a patient has previously received.”
The findings also can help with guideline development, including the management of difficult-to-treat RA, which is a focus of a new European League Against Rheumatism task force, Dr. Hyrich says.
Stanley Cohen, MD, a clinical professor in the department of internal medicine at the UT Southwestern Medical Center in Dallas, and in private practice in Dallas, expresses surprise that a higher percentage of patients wasn’t biologic refractory, although that may be due to the authors’ definition of refractory, he says. “It was interesting that rheumatologists are cycling therapies more frequently now than in the past, which I think reflects the treat-to-target approach targeting remission/low disease activity status as well as patient expectations,” Dr. Cohen says.
Dr. Cohen would like to see similar research performed in the U.S. and a consistent definition of refractory disease established so clinicians can accurately compare observational study results in different populations.
Vanessa Caceres is a medical writer in Bradenton, Fla.
References
- Kearsley-Fleet L, Davies R, De Cock D, et al. Biologic refractory disease in rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis. 2018 Oct;77(10):1405–1412.
