PT  - JOURNAL ARTICLE
AU  - Pappas, Dimitrios A
AU  - St John, Gregory
AU  - Etzel, Carol J
AU  - Fiore, Stefano
AU  - Blachley, Taylor
AU  - Kimura, Toshio
AU  - Punekar, Rajeshwari
AU  - Emeanuru, Kelechi
AU  - Choi, Jeannie
AU  - Boklage, Susan
AU  - Kremer, Joel M
TI  - 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
AID  - 10.1136/annrheumdis-2020-217209
DP  - 2021 Jan 01
TA  - Annals of the Rheumatic Diseases
PG  - 96--102
VI  - 80
IP  - 1
4099  - http://ard.bmj.com/content/80/1/96.short
4100  - http://ard.bmj.com/content/80/1/96.full
SO  - Ann Rheum Dis2021 Jan 01; 80
AB  - Objectives This study evaluated the comparative effectiveness of a tumour necrosis factor inhibitor (TNFi) versus a non-TNFi (biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs)) as the first-line treatment following conventional synthetic DMARDs, as well as potential modifiers of response, observed in US clinical practice.Methods Data were from a large US healthcare registry (Consortium of Rheumatology Researchers of North America Rheumatoid Arthritis Registry). The analysis included patients (aged ≥18 years) with a documented diagnosis of rheumatoid arthritis (RA), a valid baseline Clinical Disease Activity Index (CDAI) score of >2.8 and no prior bDMARD or tsDMARD use. Outcomes were captured at 1-year postinitiation of a TNFi (adalimumab, etanercept, certolizumab pegol, golimumab or infliximab) or a non-TNFi (abatacept, tocilizumab, rituximab, anakinra or tofacitinib) and included CDAI, 28-Joint Modified Disease Activity Score, patient-reported outcomes (including the Health Assessment Questionnaire Disability Index, EuroQol-5 Dimension score, sleep, anxiety, morning stiffness and fatigue) and rates of anaemia. Groups were propensity score-matched at baseline to account for potential confounding.Results There were no statistically significant differences observed between the TNFi and non-TNFi treatment groups for outcomes assessed, except the incidence rate ratio for anaemia, which slightly favoured the TNFi group (19.04 per 100 person-years) versus the non-TNFi group (24.01 per 100 person-years, p=0.03). No potential effect modifiers were found to be statistically significant.Conclusions The findings of no significant differences in outcomes between first-line TNF versus first-line non-TNF groups support RA guidelines, which recommend individualised care based on clinical judgement and consideration of patient preferences.