Reasons and Predictors of Treatment Change in Rheumatoid Arthritis Patients Treated with Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs: A Single-Center Retrospective Observational Study.

Abstract

Rheumatoid arthritis (RA) patients receiving biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) often experience treatment changes due to inefficacy or adverse events. The purpose of this study was to clarify the incidence and reasons for change of b/tsDMARDs in a cohort of Japanese patients with RA and to identify the predictors of treatment change. This was a retrospective observational study of RA patients prescribed b/tsDMARD between April 2011 and December 2020 at the Kindai University Nara Hospital. We focused on the change of first-line b/tsDMARDs and identified the reasons for change using the electronic medical records. Logistic regression analysis was performed to identify predictors of treatment change as the objective variable and baseline characteristics as the explanatory variable. The reasons for treatment change were inefficacy in 69.6% of cases and adverse events in 29.7% of cases. Concomitant administration of higher dose prednisolone at baseline (adjusted odds ratio: [95% confidence interval]: 2.52 [1.19-5.33]) and old age (2.00 [1.03-3.87]) were associated with change in b/tsDMARD treatment due to inefficacy within 2 years of initiation. A better understanding of b/tsDMARDs persistence and elucidating the predictors of treatment change can help improve treatment outcomes for RA.