Factors influencing delayed attainment of low disease activity in rheumatoid arthritis patients continuing targeted therapy.

Background/aims: To identify factors associated with achieving low disease activity (LDA) after 48 weeks of targeted therapy in patients with rheumatoid arthritis (RA) despite not meeting treat-to-target (T2T) criteria at week 24.

Methods: Data were collected from a multicenter, prospective observational cohort of Korea patients with RA receiving targeted therapy between April 2020 and July 2023. Patients who continued their initial targeted therapy despite not achieving LDA at week 24 were assigned to the LDA and non-LDA groups at week 48. Multivariable logistic regression was employed to identify factors associated with achieving delayed LDA at week 48.

Results: Among 456 patients with RA receiving targeted therapy, 213 were included in the analysis: 96 and 117 in the LDA and non-LDA groups, respectively. Patients with more comorbidities (HR 0.40, 95% CI 0.22-0.73) and those with seropositive RA (HR 0.15, 95% CI 0.03-0.70) were less likely to achieve LDA at week 48. Conversely, significant reductions in DAS28-ESR (HR 2.42, 95% CI 1.27-4.60) and HAQ-DI (HR 2.70, 95% CI 1.46-5.01) from enrolment to week 24, along with the absence of non-steroidal anti-inflammatory drug (NSAID) use at week 24 (HR 2.15, 95% CI 1.06-4.38), were associated with a greater likelihood of achieving delayed LDA at week 48.

Conclusion: Many patients with RA can achieve delayed LDA with continued targeted therapy without adhering to the T2T strategy. Key factors include fewer comorbidities, seronegative RA, substantial disease activity reduction in the first 24 weeks, and stopping NSAID at week 24.