Management and treatment outcomes of rheumatoid arthritis in the era of biologic and targeted synthetic therapies: evaluation of 10-year data from the KURAMA cohort

Takayuki Fujii; Koichi Murata; Hideo Onizawa; Akira Onishi; Masao Tanaka; Kosaku Murakami; Kohei Nishitani; Moritoshi Furu; Ryu Watanabe; Motomu Hashimoto; Hiromu Ito; Takao Fujii; Tsuneyo Mimori; Akio Morinobu; Shuichi Matsuda

doi:10.1186/s13075-023-03251-z

Management and treatment outcomes of rheumatoid arthritis in the era of biologic and targeted synthetic therapies: evaluation of 10-year data from the KURAMA cohort

Arthritis Res Ther. 2024 Jan 9;26(1):16. doi: 10.1186/s13075-023-03251-z.

Authors

Takayuki Fujii^{1

2}, Koichi Murata^{3

4}, Hideo Onizawa³, Akira Onishi³, Masao Tanaka³, Kosaku Murakami⁵, Kohei Nishitani⁴, Moritoshi Furu⁶, Ryu Watanabe⁷, Motomu Hashimoto⁷, Hiromu Ito^{4

8}, Takao Fujii⁹, Tsuneyo Mimori^{10

11}, Akio Morinobu¹¹, Shuichi Matsuda⁴

Affiliations

¹ Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan. fujiit@kuhp.kyoto-u.ac.jp.
² Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan. fujiit@kuhp.kyoto-u.ac.jp.
³ Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan.
⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan.
⁵ Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan.
⁶ Furu Clinic, 1098 Terasho, Konancho, Koka, Shiga, 5203301, Japan.
⁷ Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahicho, Abeno, Osaka, 5450051, Japan.
⁸ Department of Orthopaedic Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kuchiki, Okayama, 7100052, Japan.
⁹ Department of Rheumatology and Clinical Immunology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 6410012, Japan.
¹⁰ Takeda Clinic for Rheumatic Diseases, 606-3-2, Higashi-Shiokojicho, Sanoh Kyotoekimae Building 1F, Kyoto, 6008216, Japan.
¹¹ Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo, Kyoto, 6068507, Japan.

Abstract

Background: Advances in rheumatoid arthritis (RA) treatment, highlighted by biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs), have altered the paradigm of RA treatment in the last decade. Therefore, real-world clinical evidence is needed to understand how treatment strategies and outcomes have changed.

Methods: Using an observational cohort of RA from 2012 to 2021, we collected cross-sectional data of RA patients annually to analyze a trend in RA management. For patients who initiated b/tsDMRDs, we evaluated treatment outcomes between b/tsDMARDs. Mixed-effect models were applied to examine the statistical implications of changes over time in treatment outcomes with a background adjustment.

Results: We analyzed annual cross-sectional data from 5070 patients and longitudinal data from 1816 patients in whom b/tsDMARDs were initiated between 2012 and 2021. b/tsDMARD use increased, whereas glucocorticoid use decreased from 2012 to 2021. Disease activity and functional disability measures improved over time. The percentage of tsDMARD prescriptions considerably increased. All b/tsDMARDs showed clinical improvements in disease activity and functional disability. Statistically, TNFi showed better short-term improvements in b/tsDMARD-naïve patients, while IL6Ri demonstrated significant long-term benefits. IL6Ri had better retention rates in switched patients. After adjustment for patient characteristics, the annual change of RA disease activity and functional disability fared significantly better from 2012 to 2021.

Conclusions: With the development of new RA therapeutics, overall treatment outcomes advanced in the past decade.

Keywords: Biologics; Cohort study; JAK inhibitors; Rheumatoid arthritis; Treatment outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / drug therapy
Biological Products* / therapeutic use
Cross-Sectional Studies
Humans
Treatment Outcome

Substances

Antirheumatic Agents
Biological Products