RHEUMATOID ARTHRITIS AND PATIENT BURDEN OF DISEASE

OBJECTIVES: To describe patient reported outcomes (PROs) among those who have initiated targeted biologic treatment in a US observational cohort of patients with Rheumatoid Arthritis (RA). METHODS: Eligible patients were from the Corrona RA registry who had initiated a biologic agent between 2001-2016 and had a 6 month follow-up visit post initiation. Outcomes included the Clinical Disease Activity Index (CDAI), pain and fatigue (visual analog score; 0-100); morning stiffness (yes/no and hours); patient reported depression and anxiety; and others. Participants were grouped by initiation of a biologic: 1st line initiators, (patients initiating their 1st biologic), 2nd line initiators, and 3rd+ line initiators and by Tumor Necrosis Factor inhibitors (TNFi) and non-TNFi therapies. Means (SD) of outcomes are presented as changes between initiation and the 6 month follow-up visit by line of therapy. RESULTS: 11,299 patients initiated a biologic agent, 79% were female with mean (SD) age of 56.9 (12.9) years. Mean (SD) CDAI improvements from baseline to follow-up were -8.9 (14.2) 1st line, -6.6 (13.5) 2nd line, -6.4 (14.1) 3rd+ line. Mean CDAI improvements in TNFi initiators were -9.11st line, -5.9 2nd line, -5.5 3rd+ line vs -6.9, -7.8 and -6.9 in non-TNFi initiators, respectively. Follow-up average (SD) pain scores by line of therapy were 33.5 (27.5), 39.6 (27.7), 46.9 (27.7) (changes of -10.9, -7.5 and -7.5); fatigue scores: 39.0 (29.8), 43.7 (29.7) and 51.6 (28.6) (changes of -6.8, -4.6 and -5.0). 71%, 78% and 85% still experienced morning stiffness (average 1.5-2.0 hours/day at follow-up). Patient reported anxiety and depression were similar at baseline and follow-up. CONCLUSIONS: Despite many therapies to treat RA, patients still experience significant burden of disease. For the majority of outcomes, biologic naive patients reported the largest improvements; lesser improvements occurred in 2nd and 3rd line initiators. Initiators of non-TNFi had more homogenous changes across lines of therapy.