Biologicals Improve RA Function More Than Other DMARDs

Janis C. Kelly

December 04, 2013

Patients with RA who use biological disease-modifying anti-rheumatic drugs (bDMARDs) are more likely to have clinically relevant improvement in physical function compared with patients taking nonbiologic DMARDs (nbDMARDs), according to a meta-analysis reported in an article published online August 14 and in the December issue of Rheumatology.

"Our key finding was that compared to nbDMARDs, biologics produced clinically meaningful improvement in functional status in more than 50% of the patients," lead author Johanna Callhoff, MSc told Medscape Medical News. Callhoff is a biostatistician at Deutsches Rheuma-Forschungszentrum, Berlin, Germany.

The meta-analysis included 35 randomized clinical trials: 10 with DMARD-naive patients and 25 with patients who had prior inadequate response to DMARDs. The trials included abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, or rituximab compared with either nbDMARDs or placebo. The main outcome measure was improvement in physical function measured by change in Health Assessment Questionnaire (HAQ) scores.

"Our findings suggest that compared to nbDMARDs, the effect on physical function of biologics is greater for patients who are nonresponders for [methotrexate and/or other nbDMARDs. This confirms current treatment recommendations to start treatment with nbDMARDs, and only if the patient does not respond well to these [to] proceed to the use of biologics," Callhoff said.

The researchers reported that mean HAQ at baseline was a relatively high 1.0 to 2.0. More than 50% of patients had an improvement in HAQ score of about 0.28, which exceeded the minimal clinically important difference of 0.22.The analysis did not show significant clinical differences between the biologics.

"I agree with their major results, that biologics lead to a greater improvement of physical function than nbDMARDs, which support our thoughts," said Yoshiya Tanaka, MD, PhD, professor and chairman of internal medicine at the University of Occupational and Environmental Health, Kitakyushu, Japan. Dr. Tanaka, who was not involved in the meta-analysis, participated in the Humira Discontinuation Without Functional and Radiographic Damage Progression Following Sustained Remission (HONOR) trial.

"From the results, the improvement was greater for DMARD inadequate responders...than for DMARD-naive patients, indicating that biologics should be chosen in RA patients with active disease and higher HAQ-Disability Index despite nbDMARDs therapy," Dr. Tanaka added.

Theodore Pincus, MD, who also was not involved in the meta-analysis, told Medscape Medical News, "All these studies are designed for guidance but cannot be applied directly to every individual patient." Dr. Pincus is principal investigator in the Yazici Rheumatology Clinical Outcomes Research Unit at the Department of Medicine (Rheumatology) and Hospital for Joint Diseases and Medicine (Rheumatology-HJD) in New York City.

The authors, Dr. Tanaka, and Dr. Pincus have disclosed no relevant financial relationships.

Rheumatology. 2013;52:2127-2135. Abstract

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