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Background: Since the publication of difficult-to-treat rheumatoid arthritis (D2TRA) criteria1, several studies have attempted to establish the most appropriate pharmacological and non-pharmacological strategies for the management of these patients. However, data on the treatment of choice for patients who become D2TRA are still scarce. Objectives: To evaluate the survival of different biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARD) administered after fulfilling the D2TRA criteria. To assess clinical factors related to the survival of these treatments. Methods: This retrospective cohort study included D2TRA patients according to EULAR definition. Sociodemographic characteristics, clinical and serological features and disease activity data were collected at the start of the 1st b/tsDMARD. The DAS28 was also collected at the start of the following treatment after meet D2T classification and at 6 months and patients were followed-up at least for one year. Drug retention of the subsequent line of b/tsDMARD was assessed by Kaplan–Meier plots using the log-rank test. Predictive factors affecting the discontinuation were evaluated using the univariate and multivariate analysis by the Cox proportional hazard model. Results: Of the 122 patients included, 75 maintained active treatment (61.5%) with the subsequent line after D2T compared to 37 patients (38.5%) who discontinued this treatment and required more sucessive lines of b/tsDMARDs. The treatments used after D2T were TNFi (17 patients), anti-IL6R (31 patients), abatacept (27 patients), rituximab (27 patients) and JAKi (20 patients). The mean survival of the treatments was 78.3 ± 7.6 months and the percentage of patients who maintained the treatment after D2T was 29.4% for TNFi, 29.6% for abatacept, 74.2 % for anti-IL6R, 88.9 % for rituximab and 75.0% for JAKi. Significant differences were assessed between different b/tsDMARDs (log-rank pConclusion: Once patients meet D2TRA criteria, the subsequent line of b/tsDMARDs with the best survival is rituximab, followed by JAKi and anti-IL6R being TNFi and abatacept the choices with leass retention rate. Moreover, the DAS28 in the first 6 months of starting the treatment after D2T was an independent risk factor for drug survival. REFERENCES: 1 Nagy G et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021;80:31-5. Acknowledgements: NIL. Disclosure of Interests: Marta Novella-Navarro Lilly, UCB, Galapagos and Amgen, Virginia Ruiz: None declared, Natalia López-Juanes: None declared, Chafik Alejandro Chacur: None declared, Irene Monjo-Henry Lilly, UCB, Abbvie, Laura Nuño: None declared, Monica Giselle Kafati Sarmiento: None declared, Diana Peiteado: None declared, Alejandro Villalba: None declared, Elisa Fernández-Fernández: None declared, María Sanz-Jardón: None declared, Raimon Sanmarti: None declared, Chamaida Plasencia-Rodríguez Lilly, UCB, Amgen, Galapagos, Pfizer, Alejandro Balsa Roche, Lilly, Abbvie, Galapagos, UCB, Pfizer.
Novella-Navarro et al. (2024) studied this question.