Objective Despite advances in rheumatoid arthritis (RA) treatment, a considerable proportion of patients exhibit refractory disease, prompting the need for a comprehensive understanding of refractory RA. We aimed to analyze the burden and patient experiences associated with initiation of a third biologic or targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) (BT3‐RA) in a large observational cohort. Methods Data were obtained from participants with RA in the FORWARD Databank from 1999 to 2019. Participants, stratified into BT3‐RA and a comparator BT1‐RA (first initiation of a b/tsDMARD) cohorts, were matched based on key demographic and disease‐specific parameters. Demographics, patient‐reported outcomes (PROs), comorbidities, and health care interactions were assessed at initiation of first advanced therapy and at the time of meeting BT3‐RA criteria. Results After matching, 1,384 participants were included in the study (692 each for BT3‐RA and BT1‐RA). The BT3‐RA cohort had worse PROs, greater comorbidity burden, and lower health satisfaction than BT1‐RA controls. Those with BT3‐RA had significantly higher odds of having a greater number of rheumatology visits in the previous six months than controls (>4 visits, 0–2 visit reference, odd ratio OR 3.8 95% confidence interval (CI) 2.7–5.4, P < 0.001; 3–4 visits, 0–2 visit reference, OR 1.9 95% CI 1.5–2.5; P < 0.001). Those with BT3‐RA also had higher odds of concomitant glucocorticoid use (OR 1.5 95% CI 1.2–2.0, P < 0.001) and gastrointestinal disorders (OR 1.5 95% CI 1.1–1.9, P < 0.01). Conclusion Exposure to three advanced RA therapies was associated with significant disease burden and unmet health care needs. These findings underscore the importance of well‐defined refractory criteria and the need for further investigation into this RA phenotype to identify targeted treatment strategies and ultimately improve outcomes. image
Wipfler et al. (Sun,) studied this question.