What is next for RA patients who have not responded to conventional treatment?

This study compared the effectiveness of two different treatments in rheumatoid arthritis (RA) patients who have not responded well to conventional treatment with disease-modifying anti-rheumatic drugs (DMARDs). The authors concluded that changing to a biological drug showed better remission rates than switching to an alternative DMARD.

Conventional disease-modifying anti-rheumatic drugs (DMARDS), such as methotrexate (Rheumatrex), are usually prescribed as a first-line treatment for RA. However, it has been estimated that about one-third of patients will discontinue this treatment. This is can be due to poor treatment response or serious side effects, such as gastrointestinal problems (affecting the stomach and digestive system).

Some patients will simply switch to another variety of DMARD while other patients will switch to a biological drug. Tumor necrosis factor inhibitors (TNFI), such as etanercept (Enbrel), are one type of biological drug that can be effective in patients who have not responded well to DMARDs. It is currently unclear if one of these alternatives is more effective than the other in RA patients with moderate to high disease activity. 

This study compared the effectiveness of switching to another form of DMARD versus switching to a TNFI treatment in RA patients with moderate to high disease activity.

Patients had all had previous unsuccessful treatment with at least one DMARD. There were 356 patients beginning treatment with TNFIs and 586 patients who were switching to an alternative DMARD. The authors compared treatment response in both groups. 147 patients in each group were matched based on their medical history and current.

The overall disease remission rate at 1 year was 19.1% in the TNFI group. This was significantly higher compared to the DMARD group (18.4%). In the matched pairs, the remission rate in the TNFI group (19.7%) was also significantly higher compared to the DMARD group (15%).

29.9% of patients in the DMARD group and 11.6% of patients in the TNFI group were not available at the 1-year follow-up. For the patients that completed the study, the overall the remission rate in the TNFI group (37.2%) was significantly higher compared to the DMARD group (28%). Among the matched pairs, TNFI treatment was associated with a 35.4% remission rate. This was significantly higher compared to DMARD (19.1%).

No significant differences were observed in functional ability and quality of life. 

The authors concluded that TNFI treatment can achieve better remission rates than switching to an alternative DMARD among RA patients who have previously undergone unsuccessful DMARD treatment.