Number of previous DMARDs linked to reduced drug response in rheumatoid arthritis

People who have been on more disease-modifying antirheumatic drugs (DMARDs) and have had rheumatoid arthritis for a longer time are less likely to respond to rheumatoid arthritis drugs, says new research in Annals of the Rheumatic Diseases.

Data was analysed from two trials in people with rheumatoid arthritis (average duration 11 years) receiving adalimumab and methotrexate.

The research group assessed how well people were responding to the treatment after 24 weeks. A greater number of DMARDs was associated with smaller improvements in disease activity scores and health assessment questionnaires.

“A delay in initiating DMARDs can negatively affect long-term outcomes and be associated with greater disease activity, more extensive joint damage and worsened physical disability in patients with rheumatoid arthritis,” the research group says about their findings. “Conversely, rapid implementation of conventional synthetic DMARDs or tumor necrosis factor inhibitors results in better disease control than delaying start of therapy.

“However, longer disease duration is not necessarily associated with reduced clinical responsiveness based on observations that patients with different disease durations achieve similar outcomes in clinical trials,” they added. “In contrast, patients with rheumatoid arthritis who have failed methotrexate or TNF [inhibitor] therapy have much lower response rates than methotrexate naive patients, although it is not clear if these differences are primarily related to having failed an increasing number of prior DMARD therapies or increasing disease duration.

“These results support recommendations that combination therapy with a biologic agent and methotrexate be initiated without delay in patients who do not have a satisfactory response to treatment with methotrexate alone.”

Click here to read the original research. 

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