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Introduction <p>This study aimed to evaluate a subsequent treatment response among patients with rheumatoid arthritis (RA) who initiated and remained on a first-line tumor necrosis factor inhibitor (TNFi) after achieving or not achieving an initial response.</p> Methods <p>This real-world, retrospective cohort study included patients with RA in moderate/high disease activity (MDA/HDA), defined by Clinical Disease Activity Index (CDAI) score &gt; 10, who initiated a first-line TNFi and remained on therapy for ≥ 12&#xa0;months. Data were analyzed according to the time of initial evaluation: 3&#xa0;months (<i>N</i> = 1215) or 6&#xa0;months (<i>N</i> = 1318). Primary outcome: proportion of patients achieving low disease activity (LDA)/remission in CDAI (≤ 10) at the initial evaluation; secondary outcome: proportion of patients achieving minimal clinically important difference (MCID) in CDAI. Patients were categorized as responders or nonresponders according to outcome achievement, then analyzed for subsequent response at 12&#xa0;months and maintenance of initial response through 12&#xa0;months.</p> Results <p>After 3&#xa0;months, 65.9% of patients were in MDA/HDA. Among these nonresponders, 73.5% remained in MDA/HDA at 12&#xa0;months and 64.2% failed to improve through 12&#xa0;months. Of patients in LDA/remission at 3&#xa0;months, 27.0% lost their response at 12&#xa0;months. Among the 59.2% of nonresponders at 6&#xa0;months, 80.1% were in MDA/HDA at 12&#xa0;months and 74.5% never improved through 12&#xa0;months. For patients in LDA/remission at 6&#xa0;months (40.8%), 23.4% subsequently lost their response at 12&#xa0;months. Similar trends were observed for achievement of MCID in CDAI.</p> Conclusions <p>In patients with RA treated with a first-line TNFi, most patients who did not achieve a treatment target at an initial evaluation also failed to achieve the treatment target at 12&#xa0;months. Therefore, evaluating treatment as early as 3&#xa0;months after initiation may help indicate future clinical improvements and could serve as a reasonable timepoint to consider changing therapy for patients with an inadequate response.</p>

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Real-World Analysis of Initial Clinical Response and Future Outcomes Among Patients with Rheumatoid Arthritis Initiating and Remaining on a First-Line Tumor Necrosis Factor Inhibitor in the United States

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  • 发表日期：

    2025年11月14日

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  • Christina Charles-Schoeman,
  • Patrick Zueger,
  • Erin McDearmon-Blondell,
  • Siran Fang,
  • Yi Peng,
  • Tanjinatus Oishi,
  • Manish Jain,
  • John Tesser

摘要

Introduction

This study aimed to evaluate a subsequent treatment response among patients with rheumatoid arthritis (RA) who initiated and remained on a first-line tumor necrosis factor inhibitor (TNFi) after achieving or not achieving an initial response.

Methods

This real-world, retrospective cohort study included patients with RA in moderate/high disease activity (MDA/HDA), defined by Clinical Disease Activity Index (CDAI) score > 10, who initiated a first-line TNFi and remained on therapy for ≥ 12 months. Data were analyzed according to the time of initial evaluation: 3 months (N = 1215) or 6 months (N = 1318). Primary outcome: proportion of patients achieving low disease activity (LDA)/remission in CDAI (≤ 10) at the initial evaluation; secondary outcome: proportion of patients achieving minimal clinically important difference (MCID) in CDAI. Patients were categorized as responders or nonresponders according to outcome achievement, then analyzed for subsequent response at 12 months and maintenance of initial response through 12 months.

Results

After 3 months, 65.9% of patients were in MDA/HDA. Among these nonresponders, 73.5% remained in MDA/HDA at 12 months and 64.2% failed to improve through 12 months. Of patients in LDA/remission at 3 months, 27.0% lost their response at 12 months. Among the 59.2% of nonresponders at 6 months, 80.1% were in MDA/HDA at 12 months and 74.5% never improved through 12 months. For patients in LDA/remission at 6 months (40.8%), 23.4% subsequently lost their response at 12 months. Similar trends were observed for achievement of MCID in CDAI.

Conclusions

In patients with RA treated with a first-line TNFi, most patients who did not achieve a treatment target at an initial evaluation also failed to achieve the treatment target at 12 months. Therefore, evaluating treatment as early as 3 months after initiation may help indicate future clinical improvements and could serve as a reasonable timepoint to consider changing therapy for patients with an inadequate response.