ArticleClinical rheumatology2017
Factors influencing the choice of first- and second-line biologic therapy for the treatment of rheumatoid arthritis: real-life data from the Italian LORHEN Registry.
Article in Clinical rheumatology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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Who cites it
32 citing papers in PubMed, 43 citations in OpenAlex.
- The effect of tumor necrosis factor-alpha on rheumatoid arthritis-related pain: overview of evidence and mechanistic pathways.Croatian medical journal · 2026Review
- Exploring the beneficial effects of curcumin-based hydrogel beads in rats with rheumatoid arthritis induced by Freund's complete adjuvant.Molecular and cellular biochemistry · 2026Article
- Medical Ozone Increases Methotrexate Effects in Rheumatoid Arthritis Through a Shared New Mechanism Which Involves Adenosine.International journal of molecular sciences · 2025Review
- Roles of Immunity and Endogenous Retroelements in the Pathogenesis of Rheumatoid Arthritis and Treatment Strategies.Functional & integrative genomics · 2025Review
- Rheumatoid arthritis unmasked: the power of B cell depletion therapy.Molecular biology reports · 2025Review
- Nano-based Therapeutics for Rheumatoid Arthritis: Recent Patents and Development.Recent patents on nanotechnology · 2025Review
- Predictors of Drug Retention and Survival Rate of bDMARDs in Rheumatoid Arthritis: A Four-Year Real-Life Tunisian Experience.Mediterranean journal of rheumatology · 2024Article
- Decoding Behcet's Uveitis: an In-depth review of pathogenesis and therapeutic advances.Journal of neuroinflammation · 2024Review
- Review
- Managing Disease-Modifying Antirheumatic Drugs (DMARDs) for Patients Undergoing Elective Spine Surgery: A Pilot Survey.Spine surgery and related research · 2024Article
- Comparative efficacy of five approved Janus kinase inhibitors as monotherapy and combination therapy in patients with moderate-to-severe active rheumatoid arthritis: a systematic review and network meta-analysis of randomized controlled trials.Frontiers in pharmacology · 2024Review
- Real-world retention rates of biologics in patients with rheumatoid arthritis.Scientific reports · 2023Article
- Dos and don'ts in designing a computerized oral and lip squamous cell cancer registry.BMC health services research · 2023Article
- Assessing disease activity of rheumatoid arthritis patients and drug-utilization patterns of biologic disease-modifying antirheumatic drugs in the Tuscany region, Italy.Frontiers in pharmacology · 2023Article
- Difficult-to-Treat Rheumatoid Arthritis in Older Adults: Implications of Ageing for Managing Patients.Drugs & aging · 2022Article
- Patterns of biologic and targeted-synthetic disease-modifying antirheumatic drug use in rheumatoid arthritis in Australia.Rheumatology (Oxford, England) · 2022Article
- Developing A Minimum Data Set for A Rheumatoid Arthritis Registry in Iran.Mediterranean journal of rheumatology · 2022Article
- Single-centre experience of refractory rheumatoid arthritis.Rheumatology advances in practice · 2022Article
- Trajectories of Adherence to Biologic Disease-Modifying Anti-Rheumatic Drugs in Tuscan Administrative Databases: The Pathfinder Study.Journal of clinical medicine · 2021Article
- Management of Rheumatoid Arthritis: An Overview.Cells · 2021Review
Corrections and comments
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Authors and funding
12 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
According to international recommendations, the selection of the biologic disease modifying anti-rheumatic drug (bDMARD) for rheumatoid arthritis (RA) is mainly left to the clinician's preference. We analyzed the real-life factors influencing the first-line choice or the switching strategy, focusing on the prescription of abatacept (ABA) or tocilizumab (TCZ) compared to TNFα inhibitors (TNFi). Patients enrolled in the Lombardy Rheumatology Network (LORHEN) Registry after January 1, 2010, when all considered bDMARD agents were available, were included. The population was divided into "first-" and "second-line" bDMARD. We included 1910 patients (first line n = 1264, second line n = 646). Age was higher in ABA or TCZ vs TNFi treated patients (p < 0.0001). Positive latent tuberculosis screening was associated with first-line ABA (p = 0.002). Methotrexate (MTX) combination therapy was lower in the TCZ group (p = 0.02). The type (dyslipidemia, hypertension, pulmonary disease) and the number of comorbidities influenced the choice towards ABA (p = 0.01). Multinomial logistic regression demonstrated that a second-line treatment, higher age, dyslipidemia, pulmonary disease, other comorbidities, and extra-articular RA manifestations were associated with ABA compared to TNFi. TCZ was associated with a second-line treatment, higher age, and more severe disease activity. Stopping the first bDMARD due to adverse events (AE) influenced the choice towards ABA. In real life, higher age and comorbidities influence the choice towards ABA and TCZ compared to TNFi. ABA was preferred in case of suspension of previous treatments due to AE. After failing a first-line TNFi, swapping to a different mechanism of action is more common.
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