Study results support the recommended use of bDMARDs in combination with csDMARDs in patients with RA.
Recent data published in BMJ Open support the use of etanercept as a first-line tumor necrosis factor inhibitor (TNFi) monotherapy and strengthen the currently recommended use of biologic disease-modifying antirheumatic drugs (bDMARDs) in combination with conventional synthetic DMARDS (csDMARDs) in patients with rheumatoid arthritis (RA).
The objective of the Record-linkage on Rheumatic Diseases (RECORD) analyses was to assess the persistence of treatment of different bDMARDs when administered as monotherapy compared with csDMARD combination therapy in patients with RA who received first-line biologic agents. The RECORD study was promoted by the Italian Society for Rheumatology to monitor the health burden of rheumatic diseases in Italy between 2004 and 2013.
A total of 4478 patients with RA were included in the study. Among the participants, 17.84% received bDMARD monotherapy and 82.16% were treated with csDMARDs. The most often prescribed bDMARDs included etanercept (39.91%), adalimumab (25.52%), and infliximab (19.23%). Etanercept was the most prescribed agent, both as monotherapy (48.19%) and as part of combination therapy (38.11%).
The use of bDMARD monotherapy was associated with a higher Charlson Comorbidity Index, longer disease duration, and lower use of nonsteroidal anti-inflammatory drugs or glucocorticoids. Compared with the use of monotherapy, the use of combination therapy with 1 or more csDMARD was associated with a lower risk for drug failure (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.72-0.88).
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