OBJECTIVES: Rapidly managing rheumatoid arthritis (RA) is critical given the risks associated with uncontrolled disease (severe joint damage, infection, compromised organ function). Here we examine outcomes with biologic (b) or targeted synthetic (ts) DMARDs in b/tsDMARD-naïve patients with moderate-severe disease, to determine opportunities for care improvement.

METHODS: Data: PIONEER Rheumatology, an EMR and extracted chart note database specific to patients in care by the American Rheumatology Network. Eligibility: Adult (18+ years old) patients with RA who initiated b/tsDMARDs between Aug 2020-May 2022 (index), >180 days history, ≥365 days follow up, Clinical Disease Activity Index (CDAI) >10 at index (closest to, but within 90 days prior), and CDAI conducted at 24±4 weeks post-index. Primary endpoint: change in CDAI scores at 24±4 weeks from index. Statistics: T-test (continuous) or Pearson’s chi-square, proportions comparisons by z-test with Bonferroni correction (categorical). Minimal important difference (MID) in CDAI: ≥6 or ≥12 reduction from baseline moderate (>10 and ≤22) or severe (>22) CDAI, respectively. Low disease activity: CDAI ≤10.

RESULTS: Study population (n=450): mostly female (83%), white (239/303, 79%), and treated with TNF inhibitors at index (70%). At 24±4 weeks post-index, 59% of patients had a reduction from baseline CDAI score ≥ MID, 11% patients had increased CDAI (worsened), 8% had no change, and 22% had decreased (improved) CDAI but <MID. Patient proportions achieving MID were not significantly different by baseline CDAI or index b/tsDMARD. A significantly higher proportion of patients who achieved MID remained on the index drug at 24w (90%) compared to the group that did not reach MID (83%, p=0.045).

CONCLUSIONS: In this study, 59% of patients with moderate-severe RA achieved a timely, meaningful reduction in CDAI after initiating b/tsDMARDs. The remaining 41% (11% worsened, 30% had zero to minimal improvement) represent a population that may benefit from optimized treatment choice and/or enhanced care engagement.