Prescribing patterns and clinical outcomes of biological disease-modifying anti-rheumatic drugs for rheumatoid arthritis in Spain

C. Martinez-Múgica, G. Manso

Department of Medicine Pharmacology, University of Oviedo, Asturias, Spain. gmanso@uniovi.es

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• Pharmacology

OBJECTIVE: New treatments in rheumatoid arthritis (RA) have been developed to improve patient outcomes, raise their quality of life, and reduce joint damage, but long-term responses and remission remain low. This study aimed to analyse the Spanish prescribing patterns and the effectiveness of biological (b) disease-modifying anti-rheumatic drugs (DMARDs) available for RA in clinical practice.
PATIENTS AND METHODS: An observational retrospective study was performed in a teaching hospital, analysing the different combinations of drugs prescribed, real-life effectiveness and reasons for withdrawal.
RESULTS: In total, 210 patients were included, with 19 different patterns (pharmacological groups alone or in combination) of treatment prescribed. Most patients started their treatment with a conventional synthetic (cs) DMARD alone or in combination with a glucocorticosteroid. Among the initial patterns, treatment with only one csDMARD showed a longer duration. The time to first bDMARD was 6 years. TNF-α inhibitors are the most commonly prescribed drugs as initial biological treatments. The highest percentages of good responses and remissions were achieved with tocilizumab, etanercept and infliximab. The time to remission was also lower with tocilizumab. Lack of response, adverse effects and remission were the main causes of bDMARD withdrawal. The duration of treatments until withdrawal was similar among bDMARDs, except for rituximab, for which the duration was slightly shorter.
CONCLUSIONS: Prescribing pattern analysis showed the highest responses and remission rates with tocilizumab and TNF-α inhibitors. The main reasons for withdrawal were lack of response and adverse effects. Further research is needed to improve pharmacological RA management in real-life settings.

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