Analysis of biologic therapy in rheumatoid arthritis in a southern Spanish hospital population

Objectives

To analyze RA patients treated with biologics in a University Hospital. Proportion of patients treated with different drugs, as first, second or third choice. To know the disease activity before and after biologic therapy. To know side effects and the reasons.

Material and methods

We have reviewed all RA patients treated with biologicals from 1998 to January 2010. We include all patients with at least 6 months of follow up and analyze clinical efficacy as improvement in DAS count. We registered the cause for switch among biologic drugs and the response to a new biologic. Our hospital attends about 350.000 inhabitants and the prevalence of RA in Spain, as settled by Spanish Society for Rheumatology is 0.5%, so we could expect to have about 1800 RA patients, so we are treating about 12% of RA patients with biologicals.

Results

We have reviewed 206 patients, 68% female, mean age 56.5, average duration of the disease 10.8 years. RF positive 79.3% CCP 68.2%, erosive 58.2%. Initial DAS was 5.8 and at the end evaluation 53,6% of patients have a DAS<2.6.

Etanercept was the most used at onset (58%), 76 patients (36.4%) switched for inefficacy (62%) or side effects (21.7%).

Side effects were registered in 39%, with drug stop in 81% and hospital admission in 18.9%. The more common side effects were reactions at the injection site 33%, infectious processes 23.1% and skin alterations 17.9%.

Conclusions

The disease activity was high when biologic started, (DAS 5.8). The main cause of switching is loss of efficacy. Etanercept is the more prescribed drug to initiate biologic therapy.

Rituximab and Etanercept are used as a second option in the majority of patients. Abatacept is used only after a second switch. The improvement of patients is notorious with RA remission by DAS<2.6 in 53,6% of patients. The frequency of switch biologics is similar to other registry experiences.