Disease Control with Continued bDMARDS Possible in Severe RA when First Treatments Fail

Patients with severe rheumatoid arthritis (RA) who don’t respond to treatment with initial biological disease-modifying antirheumatic drugs (bDMARDs) may still improve on sequential bDMARDs. These patients, however, risk poor health-related quality of life, according to findings published in the journal Rheumatology.

Treatment of RA often begins with methotrexate or another conventional synthetic (cs) DMARD. These drugs work in different ways to slow or stop the inflammatory process that can damage joints. If this initial treatment does not adequately control the RA, patients may move on to treatment with a newer bDMARD, such as a TNF inhibitor. Biologic DMARDs work by copying the effects of substances naturally made by your body’s immune system.

Disease control is of course a major goal of RA treatment. It’s also important that treatment helps patients living with this chronic condition maintain their quality of life. Researchers recently evaluated quality of life among patients treated with up to three bDMARDs. If one bDMARD was not effective in a patient, he or she was given the next bDMARD in the sequence.

Researchers in Germany followed 3,875 RA patients who were on DMARD treatment for two years to assess quality of life. They compared quality of life among these patients with the general population.

Patients treated with bDMARDs experienced improvements in physical and mental symptoms during one year of treatment, even when their first or second bDMARD therapy was ineffective. These improvements appeared to last: the researchers observed them at one year and again at two years. No particular bDMARD appeared to help symptoms more than another.

Despite these improvements in symptoms, however, the patients’ healthy-related quality of life remained significantly lower compared with the general population.

Based on these findings, it appears that patients with severe RA can experience lasting improvements in symptoms with a sequence of bDMARD treatments, even when one or two bDMARDs is ineffective. Quality of life for these patients, however, remained significantly lower than the general population. This suggests the need to more research into improving quality of life for patients with severe RA.

Reference: Gerhold K, Richter A, Schneider M, et al. Health-related quality of life in patients with long-standing rheumatoid arthritis in the era of biologics: data from the German biologics register RABBIT. Rheumatology [early online publication]. May 21, 2015.

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