• Yoon-Kyoung Sung, Soo-Kyung Cho, Dam Kim, Chan-Bum Choi, Soyoung Won, So-Young Bang, Hoon-Suk Cha, Jung-Yoon Choe, Won Tae Chung, Seung-Jae Hong, Jae-Bum Jun, Hyoun Ah Kim, Jinseok Kim, Seong-Kyu Kim, Tae-Hwan Kim, Hye-Soon Lee, Jaejoon Lee, Jisoo Lee, Shin-Seok Lee, Sung Won Lee, Yeon-Ah Lee, Seong-Su Nah, Chang-Hee Suh, Dae-Hyun Yoo, Bo Young Yoon, Sang Cheol Bae, and BIOPSY and KORONA investigators.
• Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.
• Rheumatol. Int. 2017 Jun 1; 37 (6): 975-982.

ObjectiveTo compare the clinical effectiveness of two treatment strategies for active rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs): starting TNF inhibitors (TNFIs) or changing csDMARDs.MethodsWe used two nationwide Korean RA registries for patient selection. TNFI users were selected from the BIOPSY, which is an inception cohort of RA patients starting biologic DMARDs. As a control group, we selected RA patients with moderate or high disease activity from the KORONA database whose treatment was changed to other csDMARDs. After comparing baseline characteristics between the two groups in either unmatched or propensity score matched cohorts, we compared potential differences in the 1-year remission rate as a primary outcome and changes in HAQ-DI and EQ-5D scores as secondary outcomes.ResultsA total of 356 TNFI starters and 586 csDMARD changers were identified from each registry as unmatched cohorts, and 294 patients were included in the propensity score matched cohort. In the intention-to-treat analysis, TNFI starters had higher 1-year remission rates than csDMARD changers in both unmatched (19.1 vs. 18.4%, p < 0.01) and matched cohorts (19.7 vs. 15.0%, p < 0.01). In per protocol analysis, TNFI starters had much higher remission rates in unmatched (37.2 vs. 28.0%, p = 0.04) and matched cohorts (35.4 vs. 19.1%, p = 0.04). However, in matched cohorts, no significant differences were observed between two groups in HAQ-DI and EQ-5D scores.ConclusionsWe compared the clinical effectiveness of the two treatment strategies for active RA refractory to csDMARDs. TNFI starters showed higher 1-year remission rates than csDMARD changers.

36 keywords...

hide…