Survival of first line biological and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis in Chile

Introduction

In Chile, patients with refractory rheumatoid arthritis (RA) are candidates for treatment with biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Due to the cost and diversity of drugs currently available to treat RA, there is a greater need to evaluate their survival in the real world and mainly to provide local and national data.

Objectives

To describe the survival and cause of discontinuation/change of first line b/tsDMARDs in patients with active refractory RA at the rheumatology clinic of the Regional Hospital of Copiapó.

Materials and methods

Patients with refractory RA on first-line treatment with b/tsDMARDs were included. Data were obtained from the RA registry of patients from January 01, 2018, until July 31, 2023, and by reviewing medical records. Demographic and clinical characteristics of the patients, survival of b/tsDMARDs, and cause of discontinuation/change of therapy are described. Kaplan–Meier plots and log-rank tests were performed. Cox model was used to identify factors that affected treatment discontinuation.

Results

One hundred thirty patients met the selection criteria. Survival of the different treatments was calculated, excluding rituximab and tocilizumab due to n <10. There were no significant differences between the survival of the groups (anti-TNF, abatacept, tofacitinib), with p > 0.05. The mean survival time for b/tsDMARDs was 194 weeks. In this cohort, 34.62% (n = 45) of the patients had treatment discontinuation/change, with lack of efficacy representing 80%.

Conclusion

In this cohort of patients with RA, there were no statistically significant differences in survival after first-line treatment with b/tsDMARDs. The choice of initial therapy will depend on multiple clinical, demographic, economic and regulatory factors.