Is switching first-line targeted therapy for rheumatoid arthritis within 6 months of not reaching disease remission better than a traditional approach?

This study investigated whether switching a first-line targeted therapy (TT) within 6 months of not attaining low disease activity (LDA) enhances the chance of patients with rheumatoid arthritis (RA) achieving their target at the 12-month visit. The data showed an increased chance of achieving a target of remission or LDA at the 12-month visit with a TT switch within 6 months.

RA is a chronic, inflammatory disease for which several drug management options are available. Switching between available drugs is sometimes necessary to achieve remission/LDA targets.

First-line therapy is usually methotrexate (MTX; Otrexup), a conventional, synthetic disease-modifying anti-rheumatic drug (csDMARD). The addition of a biological DMARD (bDMARD) or a targeted synthetic DMARD (tsDMARD) to first-line therapy is sometimes needed to achieve treatment targets. If the remission or LDA is not met by 6 months, then therapy adjustment with an alternative bDMARD or tsDMARD, is considered.

This study addresses whether a treat-to-target (T2T) strategy with a TT switch within the first 6 months, can allow target treatments to be met at the 12-month visit.

This study included a total of 1275 patients with RA. Group 1 had 62 patients who had switched bDMARD/tsDMARD therapy within 6 months. Group 2 included 598 patients that did not require a 6-month therapy switch. Group 3 included 124 patients that did not respond to treatment within 6 months (followed a T2T strategy). Group 4 had 491 patients who were unresponsive to treatment within 6 months (did not follow a T2T strategy). The follow-up period was at least 1 year.

At 12 months, the highest improvement in the disease activity score-28 (DAS-28) was seen in group 2 (78.6%), followed by group 1 (48.4%), group 3 (40.3%), and group 4 (32.4%).

Patients that followed a T2T strategy from group 3 were 2.8 times more likely to achieve remission/LDA at the 12-month visit compared to those in group 4 who did not follow a T2T strategy.

The study showed that for patients with RA unable to achieve target goals within the first 6 months of treatment, a bDMARD/tsDMARD switch increases the chance of attaining remission/LDA at the 12-month visit.

The study was not randomized and focused on first-line bDMARD, tsDMARD therapy.