Yoon-Kyoung Sung1,2, Soo-Kyung Cho1,2, Dam Kim1,2, Chan-Bum Choi1,2, Soyoung Won2, So-Young Bang3, Hoon-Suk Cha4, Jung-Yoon Choe5, Won Tae Chung6, Seung-Jae Hong7, Jae-Bum Jun1, Hyoun Ah Kim8, Jinseok Kim9, Seong-Kyu Kim5, Tae-Hwan Kim1, Hye-Soon Lee3, Jaejoon Lee4, Jisoo Lee10, Shin-Seok Lee11, Sung Won Lee6, Yeon-Ah Lee7, Seong-Su Nah12, Chang-Hee Suh8, Dae-Hyun Yoo1, Bo Young Yoon13, Sang Cheol Bae14,15. 1. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea. 2. Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea. 3. Guri Hospital, Hanyang University, Guri, South Korea. 4. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 5. School of Medicine, Catholic University of Daegu, Daegu, South Korea. 6. Dong-A University Hospital, Busan, South Korea. 7. Kyung Hee University Hospital, Seoul, South Korea. 8. Ajou University Hospital, Suwon, South Korea. 9. Jeju National University Hospital, Jeju, South Korea. 10. Ewha Womans University Mokdong Hospital, Seoul, South Korea. 11. Chonnam National University Medical School and Hospital, Gwangju, South Korea. 12. Soonchunhyang University Cheonan Hospital, Cheonan, South Korea. 13. Inje University Ilsan Paik Hospital, Goyang, South Korea. 14. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea. scbae@hanyang.ac.kr. 15. Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea. scbae@hanyang.ac.kr.
Abstract
OBJECTIVE: To compare the clinical effectiveness of two treatment strategies for active rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs): starting TNF inhibitors (TNFIs) or changing csDMARDs. METHODS: We used two nationwide Korean RA registries for patient selection. TNFI users were selected from the BIOPSY, which is an inception cohort of RA patients starting biologic DMARDs. As a control group, we selected RA patients with moderate or high disease activity from the KORONA database whose treatment was changed to other csDMARDs. After comparing baseline characteristics between the two groups in either unmatched or propensity score matched cohorts, we compared potential differences in the 1-year remission rate as a primary outcome and changes in HAQ-DI and EQ-5D scores as secondary outcomes. RESULTS: A total of 356 TNFI starters and 586 csDMARD changers were identified from each registry as unmatched cohorts, and 294 patients were included in the propensity score matched cohort. In the intention-to-treat analysis, TNFI starters had higher 1-year remission rates than csDMARD changers in both unmatched (19.1 vs. 18.4%, p < 0.01) and matched cohorts (19.7 vs. 15.0%, p < 0.01). In per protocol analysis, TNFI starters had much higher remission rates in unmatched (37.2 vs. 28.0%, p = 0.04) and matched cohorts (35.4 vs. 19.1%, p = 0.04). However, in matched cohorts, no significant differences were observed between two groups in HAQ-DI and EQ-5D scores. CONCLUSIONS: We compared the clinical effectiveness of the two treatment strategies for active RA refractory to csDMARDs. TNFI starters showed higher 1-year remission rates than csDMARD changers.
OBJECTIVE: To compare the clinical effectiveness of two treatment strategies for active rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs): starting TNF inhibitors (TNFIs) or changing csDMARDs. METHODS: We used two nationwide Korean RA registries for patient selection. TNFI users were selected from the BIOPSY, which is an inception cohort of RApatients starting biologic DMARDs. As a control group, we selected RApatients with moderate or high disease activity from the KORONA database whose treatment was changed to other csDMARDs. After comparing baseline characteristics between the two groups in either unmatched or propensity score matched cohorts, we compared potential differences in the 1-year remission rate as a primary outcome and changes in HAQ-DI and EQ-5D scores as secondary outcomes. RESULTS: A total of 356 TNFI starters and 586 csDMARD changers were identified from each registry as unmatched cohorts, and 294 patients were included in the propensity score matched cohort. In the intention-to-treat analysis, TNFI starters had higher 1-year remission rates than csDMARD changers in both unmatched (19.1 vs. 18.4%, p < 0.01) and matched cohorts (19.7 vs. 15.0%, p < 0.01). In per protocol analysis, TNFI starters had much higher remission rates in unmatched (37.2 vs. 28.0%, p = 0.04) and matched cohorts (35.4 vs. 19.1%, p = 0.04). However, in matched cohorts, no significant differences were observed between two groups in HAQ-DI and EQ-5D scores. CONCLUSIONS: We compared the clinical effectiveness of the two treatment strategies for active RA refractory to csDMARDs. TNFI starters showed higher 1-year remission rates than csDMARD changers.
Entities:
Keywords:
Anti-TNF drugs; DMARDs; HAQ; Quality of life; Rheumatoid arthritis
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