Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France - 08/05/26
, Laurent Arnaud c, 1, Mélanie Chartier d, Arnaud Panes e, Pauline Lemeille e, Bruno Fautrel f, gHighlights |
• | Using France's nationwide SNDS claims database (≈67 million people), the study tracked 26,478 rheumatoid-arthritis patients who began their first biologic or targeted synthetic DMARD between 2014 and 2019. |
• | Tumour-necrosis-factor inhibitors were the initial choice in 62.6% of cases, yet only 48% stayed on their first drug over the follow-up; 28% moved to a second and 11% to a third agent over an average 3.8-year follow-up. |
• | After a TNFi switch, interleukin-6 receptor inhibitors and T-cell modulators became the most common second-line therapies, while anti-CD20 agents were reserved for older patients with heavier comorbidity burden. |
• | Treatment sequences broadly mirrored current EULAR recommendations, but one-quarter of patients eventually stopped all biologic/targeted DMARDs, highlighting persistent gaps in sustained RA disease control. |
Abstract |
Objectives |
The study aimed to describe nationwide treatment sequences in French patients with rheumatoid arthritis (RA) initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD).
Methods |
This analysis is based on the French National Health Claims Database (SNDS), covering over 67 million people. Patients with RA (ICD-10 codes M05, M060, M068 or M069) and ≥ 2 b/tsDMARD dispensings from January 1, 2014 to December 31, 2019 were included, and followed until December 31, 2020 or death. Differences in patients characteristics at each b/tsDMARD initiation were tested with Mann Whitney U tests and χ 2 tests.
Results |
Overall, 26 478 patients were identified (mean (SD) age 57.0 years (± 14.4)) including 70.9% females. The most frequent first-line of b/tsDMARD were TNF inhibitors (TNFi) (62.6%), followed by abatacept (CTLA4-Ig) (12.0%), rituximab (11.0%), IL-6R inhibitors (IL-6Ri) (10.0%), and JAK inhibitors (JAKi) (3.9%). The mean (SD) follow-up duration was 3.8 years (± 1.7 years,), for a total of 100 332 person-years. Throughout the study period, 12,662 patients (47.8%) maintained their first b/tsDMARD, while 7531 (28.4%) switched to a second b/tsDMARD, and 3046 (11.1%) to a third b/tsDMARD, after a mean duration of 54.1 (± 34.0), 31.9 (± 27.8) and 25.9 (± 22.2) months, respectively. In terms of mode of action associated profiles, the main discrepancies were age, higher in CD20i and LT modulator patients, and comorbidities, more prevalent in CD20i treated patients.
Conclusion |
In this nation-wide analysis of 26 478 patients, TNFi was the most frequently dispensed first-line b/tsDMARD, with LT modulators and IL-6i preferred in second-line therapy.
Le texte complet de cet article est disponible en PDF.Keywords : French national healthcare database, Prevalence, Janus kinase inhibitors, Anti-interleukin 6, Tumour necrosis factor inhibitors, Anti-CD20 monoclonal antibodies, Lymphocyte T modulators, SNDS
Plan
Vol 93 - N° 3
Article 106023- mai 2026 Retour au numéro
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