Factors affecting persistence with biologic treatments in patients with rheumatoid arthritis: a systematic literature review

ABSTRACT

Introduction: Biologic treatments are a milestone in the management of rheumatoid arthritis (RA) patients with an inadequate response to conventional synthetic treatments. With the increase in the number of biologic treatments, predictor factors of discontinuation are needed to choose the right treatment for the right patient.

Areas covered: In this article, the factors affecting persistence with biologic treatments will be covered: factors associated with the demographic characteristics and comordidities of the patients, those with the characteristics of the disease, the biomarkers, and the adherence.

Expert opinion: Seeking factors affecting persistence with biologic treatments is an important field of clinical research to offer the best management to the RA patients. Personalized medicine is the ultimate goal in this field to choose the biological therapy with the highest persistence for every patient. To achieve this goal, biomarkers could be a milestone.

KEYWORDS:

• Biologic treatments
• drug survival
• maintenance
• persistence
• rheumatoid arthritis

Article highlights

• Biologic treatments should be used in patients suffering from rheumatoid arthritis with an inadequate response to a conventional synthetic Disease-Modifying Antirheumatic Drug (csDMARD).

• From the background of the patients, comorbidities and smoking are predictors of early discontinuation of biologic treatments contrary to age, gender, smoking, body mass index, and family history of rheumatoid arthritis.

• From the characteristics of the disease, disease activity and previous exposure to biologic treatments are predictors of early discontinuation of biologic treatments contrary to antibodies and disease duration. Comedication with methotrexate was a predictor of persistence with biologic treatments.

• Only CRP has been confirmed as a biomarker associated with early discontinuation of biologic treatments.

• Adherence is an important predictor of persistence with biologic treatments and should be discussed with the patient.

This box summarizes key points contained in the article.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

JG Letarouilly reports a research grants from Pfizer, outside the submitted work. RM Flipo is a member of the national advisory board of rheumatology/immunology of Janssen. He reports research grants from Janssen and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.