Comparative effectiveness of first-line tumour necrosis factor inhibitor versus non-tumour necrosis factor inhibitor biologics and targeted synthetic agents in patients with rheumatoid arthritis: results from a large US registry study
RA treatment guidelines recommend a treat-to-target approach guided by disease stage and treatment history, yet the optimal sequence of different treatment modalities has not been established. Data from Corrona – were used to evaluate the comparative effectiveness of TNFi versus non-TNFi bDMARDs and tsDMARDs as first-line treatment following csDMARD failure. Results support RA guidelines recommending individualised care based on clinical judgement and consideration of patient preference.
The study included 4186 adult patients with a diagnosis of RA, a valid baseline CDAI greater than 2.8, and no prior b- or tsDMARDs. Outcomes including CDAI, 28-Joint Modified Disease Activity Score, PROs, and rates of anaemia were captured 1-year post-initiation. Groups were propensity score-matched to account for potential confounding. Post matching the groups appeared similar in terms of baseline characteristics.
The results showed no significant differences between TNFi and non-TNFi treatment groups for binary outcomes, including achievement of LDA and remission. For anaemia, although the raw proportion with anaemia was not different pre- and post-matching, TNFi initiators had a lower crude incidence. This real-world, comparative study revealed limited differences in baseline characteristics and clinical outcomes between RA patients initiating treatment with TNFi versus non-TNFi following csDMARD failure.