ArticleRheumatology (Oxford, England)2022
Effectiveness of sequential biologic and targeted disease modifying anti-rheumatic drugs for rheumatoid arthritis.
Article in Rheumatology (Oxford, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Anti-GM-CSF otilimab versus sarilumab or placebo in patients with rheumatoid arthritis and inadequate response to targeted therapies: a phase III randomised trial (contRAst 3).Annals of the rheumatic diseases · 2023Trial
- Remission and treatment persistence during sequential therapy in rheumatoid arthritis: results from the Estonian Biologic Treatment Registry.Rheumatology international · 2026Article
- Splenic neuromodulation as monotherapy and in combination with biologic or targeted synthetic DMARDs for difficult-to-treat rheumatoid arthritis (ConsiderRAte): a randomised, sham-controlled, early feasibility trial.EClinicalMedicine · 2026Article
- Emerging trends in the management of difficult-to-treat rheumatoid arthritis: targeted treatments and non-pharmacological interventions.Rheumatology (Oxford, England) · 2026Review
- Target Trial Emulation to Incorporate Real-World Data in the Estimation of the Clinical and Cost-Effectiveness of Biologic Treatment.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- Remission and treatment persistence during sequential therapy in rheumatoid arthritis: results from the Estonian Biologic Treatment Registry.Rheumatology international · 2026Article
- Safety of JAK inhibitors versus other biologic therapies following anti-TNF failure in patients with rheumatoid arthritis.Arthritis research & therapy · 2025Article
- Feasibility of INSELMA: an interdisciplinary nurse-coordinated self-management intervention for people with inflammatory arthritis and substantial disease impact.EULAR rheumatology open · 2025Article
- The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs.Rheumatology (Oxford, England) · 2025Article
- Potential impact of European Medicines Agency measures to minimize risk of serious side effects on JAKi prescribing and utilization in the UK.Rheumatology (Oxford, England) · 2025Article
- Defining immune cell phenotypes that distinguish treatment responders and non-responders in RA.Seminars in arthritis and rheumatism · 2025Review
- Switch from Intravenous to Subcutaneous Formulation of Tocilizumab in Rheumatoid Arthritis: Retrospective Cohort Analysis and Systematic Literature Review.Biologics : targets & therapy · 2025Article
- Timely escalation to second-line therapies after failure of methotrexate in patients with early rheumatoid arthritis does not reduce the risk of becoming difficult-to-treat.Arthritis research & therapy · 2024Article
- Patterns in the Sequential Treatment of Patients With Rheumatoid Arthritis Starting a Biologic or Targeted Synthetic Disease-Modifying Antirheumatic Drug: 10-Year Experience From a US-Based Registry.ACR open rheumatology · 2024Article
- Utilizing biologic disease-modifying anti-rheumatic treatment sequences to subphenotype rheumatoid arthritis.Arthritis research & therapy · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesWhether patients with RA benefit from repeated trials of biologic or targeted synthetic DMARDs (b/tsDMARDs) after three or more attempts is unknown. We aimed to describe treatment outcomes in each line of b/tsDMARD therapy.
methodsUsing data from the British Society for Rheumatology Biologics Register for RA from 2001 to 2020, change to a new b/tsDMARD (except biosimilar switches) was defined as a new line of therapy. Treatment outcomes were compared across lines of therapy, including DAS28 remission (≤2.6), low disease activity (LDA, ≤3.2) at 6 months and median time to drug discontinuation. Multiple imputation was used for missing data.
resultsA total of 22 934 individuals starting a first b/tsDMARD were included (mean age 56 years, 76% female), among whom 10 823 commenced a second-line drug, 5056 third, 2128 fourth, 767 fifth and 292 sixth. Most (71%) had sufficient data for DAS28-derived outcome analyses. TNF inhibitors were the most common first-line drug, but choice of subsequent-line drugs changed over time. Seventeen percent achieved DAS28 remission following first-line, 13% second and 8-13% with third through sixth. LDA was achieved in 29% of first-line, 23% second, 17-22% through to the sixth. Patients stayed on first-line therapy for a median of 2.6 years, ranging from 1.0-1.4 years for lines two to six.
conclusionMany patients will eventually benefit after repeated trials of b/tsDMARD. Further research to improve treatment selection are needed to prevent prolonged trial and error approaches in some patients.
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