Concomitant csDMARD use leads to lower bDMARD discontinuation in RA patients
Concomitant use of conventional synthetic disease-modifying antirheumatic drug (csDMARD) results in a significantly lower risk for discontinuation of biologic (b)DMARD because of adverse events (AEs) among patients with rheumatoid arthritis (RA), according to a recent study.
In addition, neither methotrexate (MTX) route of administration nor dose significantly predicted bDMARD durability.
A total of 814 patients were included, among whom 153 (18.8 percent) received bDMARD monotherapy and 661 (81.2 percent) combination csDMARD/bDMARD therapy. Of the patients, 38.7 percent discontinued bDMARD over a mean follow-up of 1.9 years.
Multivariate analysis revealed a nonsignificant trend toward lower discontinuation for the combination therapy vs monotherapy for any reason (hazard ratio [HR] ,0.76, 95 percent CI, 0.55–1.05) and owing to ineffectiveness/AE (HR, 0.73, 0.50–1.06). Moreover, the risk of bDMARD discontinuation due to AE was significantly lower among patients taking the combination therapy (HR, 0.43, 0.24–0.76).
The secondary analysis showed no statistically significant relationship between MTX dose or route of administration and bDMARD durability.
The study enrolled patients from the Ontario Best Practices Research Initiative who initiated bDMARD therapy and had ≥1 follow-up assessment. Multivariate Cox regression was used to assess the effect of concomitant csDMARD use and MTX route of administration on bDMARD discontinuation due to (1) any reason, (2) ineffectiveness, (3) AEs, or (4) both ineffectiveness and AEs.
“Prior studies have suggested that concurrent csDMARD therapy enhances the efficacy of bDMARD,” the authors said.