A study of real-world data from FORWARD, The National Databank for Rheumatic Diseases, from 1998 to 2019 indicates that refractory rheumatoid arthritis (RA) is significantly associated with higher rates of glucocorticoid and opioid use, lower satisfaction with health care, greater comorbidity, and an overall higher burden of disease, Kristin Wipfler, PhD, reported during her abstract poster presentation at ACR Convergence on November 12.

Dr Wipfler is the biobank director and analyst for epidemiological studies at FORWARD in Omaha, Nebraska.

Even with major advances in treatment of RA, Dr Wipfler noted that 6-21%of patients have are refractory to many of the available advanced therapies. “Well-defined refractory RA (reRA) criteria and thoughtful selection of controls are essential to ensure that observed differences are truly due to refractory disease and not to confounding variables,” she explained. In this study, she and colleagues sought to identify the factors most associated with reRA and to characterize the differences in experiences and disease burden between patients with reRA and matched nonrefractory controls drawing from more than 20 years of real-world data in the FORWARD Databank.

The study cohort included patients who had no history of biologic (bDMARD) or targeted synthetic DMARD (tsDMARD) use at baseline but were subsequently treated with one or more advanced therapies. The refractory group included participants who had been exposed to ≥3 advanced therapies during observation, including ≥1 TNF inhibitor (TNFi) and ≥1 tsDMARD or non-TNFi bDMARD. The nonrefractory group consisted of patients who continued use of their first advanced therapy for at least 2 years, and who never exceeded 2 advanced therapies during observation. Participants were matched 1:1 on age, sex, RA duration, calendar year, and observation time.

Among 6575 participants who met study inclusion criteria, 718 (10.9%) met the criteria for refractory RA and 692 were matched 1:1 to nonrefractory controls. Univariate analyses showed that patient-reported outcomes (PROs) were significantly worse among the reRA group at both time points. “Glucocorticoid use, opioid use, Rheumatic Disease Comorbidity Index (RDCI), gastrointestinal (GI) disorder, and polysymptomatic distress (PSD) were also all higher for the reRA group at both time points, and health care satisfaction was lower,” Dr Wipfler stated.

In multivariable analyses higher levels of pain, more GI disorders, and lower health care satisfaction were all associated with future incidence of reRA. In addition, higher education, corticosteroid use, GI disorder, and more rheumatology visits were also associated with reRA. A history of cancer was associated with nonrefractory status.

“These findings underscore the importance of well-defined reRA criteria and the need for further investigation into this unique RA phenotype to identify targeted treatment strategies and ultimately improve outcomes,” Dr Wipfler concluded.s.

Reference:

Wipfler K. 0381: Disease burden, patient experiences, and unmet needs in refractory rheumatoid arthritis: insights from 20 years of real-world data. Presented at: American College of Rheumatology Convergence. November 12, 2023. San Diego.