Rheumatology Advance Access published online on December 1, 2003
Rheumatology, doi:10.1093/rheumatology/keh057
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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Original Papers
1 Rheumatology Research Unit, First Floor, Old Nurses Home, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
* Corresponding author. E-mail: p.emery{at}leeds.ac.uk.
Received 24 April 2003
; accepted 24 September 2003
Objective. To assess the impact of escalating conventional therapy in patients with RA who satisfy BSR/NICE criteria for biologics. Methods. A total of 308 consecutive patients referred to a tertiary centre for biological therapy between January 1999 and February 2001 were studied prospectively. They were considered by their own consultant to have failed standard therapy. Prior to biologics, conventional therapy was escalated to include combination and parenteral methotrexate treatment. Patients were assessed at 12-weekly intervals for 1 yr and therapy was changed if response was not satisfactory. The subsequently released BSR/NICE biologic eligibility criteria were applied retrospectively. Response (disease activity, disability and quality of life) to escalated therapy in those patients who did or did not satisfy current eligibility criteria were compared. Results. In total, 159 satisfied BSR/NICE criteria and would have been eligible for immediate treatment with biologics [DAS28 > 5.1, failed methotrexate (20 mg/week or lower dose owing to toxicity) and one other DMARD]; however, 93 of these responded to escalated conventional therapy and did not require biologics [significant improvement (P < 0.01) in disease activity, disability and quality of life]. However, mild disease activity (DAS28 < 3.2) was only achieved in 7% of these patients at 12 months. Conclusions. Although over half the patients who satisfied standard criteria for biologics responded satisfactorily to escalated therapy, only a minority achieved mild disease activity. The savings achieved by treating with conventional therapies need to be weighed against the risk of persistent disease activity.
Key words: Rheumatoid arthritis, Anti-cytokine therapy.
The impact of escalating conventional therapy in rheumatoid arthritis patients referred for anti-tumour necrosis factor-
therapy
2 University of Leeds, Rehabilitation Research Unit, School of Medicine, 36 Clarendon Road, Leeds, LS2 9NZ, UK
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