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Longer biologic use for RA linked with
reduced disability, disease activity
Longer biologic exposure was associated with reduced disease activity and disability in a
longitudinal population of patients with rheumatoid arthritis, results of a retrospective analysis
covering a 12-year period show.
N
ancy Ann Shadick, MD, MPH, of Brigham
and Women’s Hospital, Boston, Massachu-
setts, explained that biologics have become
the standard of care for treating moderate to severe
rheumatoid arthritis in patients with an inade-
quate response to nonbiologic disease-modifying
antirheumatic drugs. Though biologics have been
proven effective in managing symptoms and dis-
ease activity, their long-term impact on disability
remains unclear.
Dr Shadick said, “Limiting the long term functional impairment that
can occur in rheumatoid arthritis is a very important goal.”
She continued, “While biologic therapy is known to improve disease
activity and symptoms of rheumatoid arthritis, understanding the
long-term impact of biologic therapy on functional capacity in patients
with rheumatoid arthritis of longer duration is important.”
Dr Shadick and colleagues used longitudinal data from a cohort of
patients with rheumatoid arthritis at a single academic medical centre
to examine the link between patient disability due to rheumatoid
arthritis and biologic exposure.
Linear mixed repeated measures regression was used to model the
impact of biologic exposure on changes in disease activity (Disease
Activity Score 28 C-reactive protein) and disability (modified Health
Assessment Questionnaire).
At each follow-up visit, biologic exposure was quantified as the ratio
of a patient’s time on a biologic relative to their time participating in
the cohort. Patients’ yearly biologic exposure, outcome scores, and
associated covariates were incorporated over a maximum of 13 years
into the longitudinal regression models to identify predictors of disease
activity and disability at the population level.
The analysis included 1395 patients with rheumatoid arthritis, 82.2%
female, with a total of 6783 unique physician visits from 2003 to
2015. Average disease duration at enrolment was 12.7 years. Longer
biologic exposure was associated with a significant reduction in annual
population means for both disease activity and disability (P < 0.0001).
Disease Activity Score 28 or modified Health Assessment Question-
naire score at enrolment was the strongest predictor of disease activity
and disability in models, respectively (P < 0.0001). Shorter disease
duration (P < 0.0001), not using a biologic at enrolment (P < 0.0001),
and use of methotrexate (P < 0.0003) were significant predictors of
reduced disease activity and disability in the models.
Dr Shadick concluded that longer biologic exposure was associated
with reduced disease activity and disability in a longitudinal population
of patients with rheumatoid arthritis. Though biologic use improves
the functional status of the population, rheumatoid arthritis status at
enrolment remains the most significant predictor of disability.
Results of the developed longitudinal models suggest that use of
biologics may help reduce long-term disease activity and disability in
patients afflicted with rheumatoid arthritis.
She added, “This study, drawn from data in the Brigham and Women’s
Hospital Rheumatoid Arthritis Sequential Study (BRASS) registry, a
real world setting cohort, demonstrated that, of patients who remain
on biologic therapy, good outcomes, improved functional status, and
reduced disease activity are observed.”
When asked about future directions of her team’s work, Dr Shadick
responded, “We will look at the impact of methotrexate use in conjunc-
tion with biologic therapy on these outcomes, how biologic therapy
impacts ongoing radiographic progression in longstanding disease,
and to what extent reduced disability and disease activity affects a
cost-effectiveness model.”
Three gene sets could predict
response to therapies for RA
Three gene expression signatures can help rheumatologists
identify patients more likely to respond to tumour necrosis factor
inhibitors or B-cell depletion therapies in patients with moderate
to severe rheumatoid arthritis.
T
his conclusion was based on results
of RNA sequencing of blood from
patients participating in the Optimal
management of Rheumatoid arthritis patients
requiring BIologic Therapy (ORBIT) study.
Duncan Porter, MD, of Queen Elizabeth
University Hospital, Glasgow, UK, explained
that ORBIT was a randomised, controlled
trial of patients with rheumatoid arthritis
in the UK. Drawing on data from ORBIT,
researchers looked for gene expression
markers that would help predict responses
to either tumour necrosis factor inhibiting
drugs or the B-cell therapy rituximab, or both.
Dr Porter, said, “The ORBIT data showed
that patients with seropositive rheumatoid
arthritis are as likely to respond to rituximab
as to anti-tumour necrosis factor therapy. A
significant proportion of patients failed to re-
spond to their first biologic drug, however, but
responded when switched to the alternative.”
He continued, “If we could identify blood
markers that predict which drug patients
were most likely to respond to, that would
allow us to choose the best treatment for
that patient at the start, rather than rely on a
trial-and-error approach.”
Dr Porter and colleagues sequenced the RNA
from the peripheral blood of 241 patients
with rheumatoid arthritis recruited for the
ORBIT study, after first depleting ribosomal
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