Fresh data from real clinical practice on targeted treatment of RA with etanercept: Should therapy be changed after 12 weeks due to insufficient response?

Goals of RA treatment − and how (and when) to respond to their non-achievement?

The goal of rheumatoid arthritis treatment is to achieve remission or at least low disease activity within 12 weeks. Doctors measure the response to therapy using the disease activity score (DAS28). Patients with DAS28 < 2.6 and minimal symptoms have achieved remission. Patients with DAS28 ≤ 3.2 and mild symptoms have achieved low disease activity (LDA). If patients do not respond to treatment within 12 weeks, it is generally recommended to change it. However, it is not precisely known how many patients would respond to therapy later if it were continued beyond the 12th week. 

The authors of the cited paper used data from the ADEQUATE study, which examined the effectiveness of etanercept over 12 months in real clinical practice in patients with rheumatic disease or psoriasis, focusing primarily on those who did not achieve the RA treatment goal (remission or LDA) after 12 weeks of treatment. 

Monitored patient group

A total of 845 RA patients were included in the study, and data from 824 of them were used for analysis. Overall, 472 patients completed the study; 239 terminated it prematurely, and 113 discontinued treatment without giving a reason, so they were not included in the analysis. The most common reasons for discontinuation were insufficient efficacy or the occurrence of adverse events. 

Women constituted 72% of the patient population included in the analysis, with an average age of 59 years. The median disease duration was 5.5 years, and most patients had previously used 2−3 conventional disease-modifying antirheumatic drugs (DMARDs; most commonly methotrexate − in 88%). The most common concomitant therapy during the study was methotrexate (46%) and prednisolone (32%).   

Findings

After 12 weeks of treatment, 24% of patients achieved remission. The number of individuals in remission increased over time. By week 24 and 36, 31% achieved remission, and by week 52, 37% did. LDA was achieved by 39% of patients at week 12 and 45% at week 24. Continuing treatment to week 52 further increased the proportion of study participants who achieved LDA, up to 54%.

During therapy, a reduction in concomitant glucocorticoid use was observed. Improvements were also noted in patient-reported parameters, even among those who did not achieve remission or LDA. No new safety signals were observed throughout the monitoring period.    

Conclusion

The number of patients who achieved remission or LDA after 12 weeks of etanercept application was significant and increased with continued treatment over time. This finding suggests that there is a subset of patients who will achieve remission or LDA after more than 12 weeks of therapy if it is continued. 

(eko)

Source: Feist E., Baraliakos X., Behrens F. et al. Effectiveness of etanercept in rheumatoid arthritis: real-world data from the German non-interventional study ADEQUATE with focus on treat-to-target and patient-reported outcomes. Rheumatol Ther 2022; 9 (2): 621−635, doi: 10.1007/s40744-021-00418-5.