ArticleRheumatology international2026
Global inequities in biologic and targeted DMARD use in rheumatoid arthritis: cross-sectional data from the international COVAD-2 cohort.
Article in Rheumatology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDespite improvement in treatment, rheumatoid arthritis (RA) management remains inconsistent.
aimsTo evaluate the worldwide disparities in the use of biological and targeted molecules (advanced) RA therapies, focusing on differences across continents and socioeconomic strata, and to identify factors associated with their utilisation.
methodsCross-sectional analysis of the international COVAD-2 cohort, including demographics, socioeconomic factors, disease characteristics, patient-reported outcomes, and treatments. Primary outcomes assessed treatment distribution by continent, secondary outcomes evaluated distribution by Human Development Index (HDI), with predictors analysed using multivariable logistic regression.
resultsAt the time of analysis, COVAD2 included 10,739 participants; 2007 had RA, 1997 with geographical data included in this study (mean age 50.9 years, 88.1% women). Most patients came from Europe (39.4%) and Asia (24.8%); 61.3% and 23.7% were from very high- and high-HDI countries, respectively. Overall, 29.6% of patients used advanced therapies, with the highest rate in Europe (44.0%), followed by North America and Oceania (33.9%), South America (31.1%), Asia (11.7%), and Africa (5.3%) (p < 0.001). Usage correlated strongly with HDI: 2.7% in low-HDI to 38.8% in very-high-HDI countries (Compared to very-high income, Odds Ratio for high 0.561 (95% CI 0.403;0.782), for medium 0.288 (95% CI 0.153;0.539), and for low income 0.275 (95% CI 0.034;2.199); p < 0.001). Regions with limited access relied more on glucocorticoids. Disparities across continents and HDI categories remained after adjusting for confounders(demographic characteristics, disease activity, comorbidities, and patient-reported outcomes.
conclusionMarked continent- and HDI-based inequities in biologic and targeted DMARD use persist globally, demanding coordinated action from the rheumatology community to ensure equitable RA care across resource settings.
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