Clinical characteristics of inadequate response to csDMARDs and bDMARDs in patients with rheumatoid arthritis: a cross-sectional, large cohort, real-world practice study

This study aims to identify clinical characteristics of inadequate response (IR) to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). This study was a retrospective, cross-sectional study based on the registry of Chinese Rheumatism Data Center (CRDC). Patients aged ≥ 18 years old with active RA (DAS28-CRP > 3.2) and at least 1 follow-up visit after baseline were included (to clarify treatment response). A total of 8326 patients in CRDC database were eligible. Within them, 6676 patients were included in analysis of IR to csDMARDs, and 3705(55.50%) of them had IR. A total of 1650 patients were included in analysis of IR to bDMARDs, and 819(49.64%) of them had IR. Data on demographics, disease characteristics, physical and laboratory tests, treatments at entry (i.e. baseline), and follow-up visits were extracted for analysis. Multivariable logistic regression was used to identify predictors of IR to csDMARDs and bDMARDs, respectively. The final multivariable logistic regression indicated that age, disease duration (Q2,Q3,Q4), DAS28-CRP, Glucocorticoids use, and Leflunomide used were the relevant clinical characteristic of csDMARDs-IR, age, disease duration (Q3,Q4), BMI, DAS28-CRP were the relevant clinical characteristic of bDMARDs-IR. Based on a large registry database, we identified clinical risk factors of IR to treatments, which may help clinicians in therapeutic medication selection in clinical practice. Many patients with rheumatoid arthritis (RA) do not get better with standard treatments, known as conventional synthetic drugs (csDMARDs) or more advanced biologic drugs (bDMARDs). This situation is called “inadequate response” (IR). Our study used a large Chinese patient database to find out which common patient characteristics are linked to a higher risk of not responding to these treatments. We analyzed data from over 8,000 patients with active RA. About half of the patients did not respond adequately to their treatments. We found that older age, longer disease duration, and higher initial levels of disease activity were relevant to the risk of not responding to both types of drugs. For patients taking csDMARDs, using a specific drug called leflunomide might be associated with a higher risk of inadequate response, while using glucocorticoids (like prednisone) was linked to a lower risk. For patients taking bDMARDs, having a lower body weight (BMI) was also a risk factor for not responding. This study helps doctors identify RA patients who might not respond well to standard treatments early on. If a patient is older, has had RA for a long time, or has high disease activity at diagnosis, their doctor might consider a more tailored and proactive treatment strategy. This could include closer monitoring, choosing different initial medications, or planning for a quicker switch to advanced therapies if needed. These findings can help guide better personal care for RA patients in clinical practice.