TNF inhibitors in early RA: do they improve long-term disease symptoms?

This study investigated if tumor necrosis factor inhibitors (TNFi) are effective as a first-line treatment of rheumatoid arthritis (RA). They found that patients treated first with TNFi had greater improvements in RA symptoms.

Rheumatoid arthritis (RA) is a chronic disease. It is caused by inflammation that leads to painful swelling in the joints. There are a number of drugs used to treat RA. One of the types of drugs used to treat RA is called biologics (BG). BG work in a different way to conventional drugs. They suppress the immune system in very specific ways. 

Conventional drugs do not manage RA symptoms in all patients. BGs are a good option for these patients. Tumor necrosis factor inhibitors (TNFi) are one type of BGs. TNFis block a protein which is important in sustaining inflammation. Recently, studies have shown that giving a patients TNFi as a first-line (FL) treatment improves RA symptoms. These studies have been short-term. It is unclear if starting a patient on TNFi will improve long-term RA symptoms. 

This study performed an analysis of 10 clinical trials. These trials included 4306 patients with early RA. Patients in these studies were taking either TNFi or conventional first-line RA treatment. In some studies, patients and doctors were blinded to which treatment was given (double-blind). In other studies, patients and doctors knew what treatment was being administered (unblinded). This study looked at the long-term RA symptoms. Disease activity (DA) was measured using standard questionnaires (such as the ACR50 and ACR70).

After 2 years, DA scores were better in TNFi patients. This result was observed in patients in the blinded trials only. DA was reduced by 68% and 52% according to the ACR50 and ACR70 scores. Remission rates (no symptoms) were improved in TNFi patients. At 5 years, all of the studies were unblinded. There was no significant difference in disease activity scores after 5 years. 

The authors concluded that patients treated first with TNFis had greater improvements in RA symptoms on the long-term (at least up to 2 years).

The non-blinded studies included in the analysis did not support the effectiveness of TNFis in early RA. More long-term, blinded studies are needed to confirm these findings.

If you have any concerns regarding RA treatment, please consult with your physician.