title: The impact of prior biologic therapy on adalimumab response in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  The aim of this study is to use data from a non-interventional study of adalimumab in patients with rheumatoid arthritis (RA) during routine clinical practice to evaluate the impact of prior treatment with biologics on the effectiveness of current therapy.
  
  
  METHODS
  Efficacy parameters were evaluated for all patients with values at baseline and month 12. Subgroup analyses were performed on patients with 0, 1, or ≥2 prior biologic agents. Key outcome measures included Disease Activity Score- 28 joints (DAS28) and Funktionsfragebogen Hannover (FFbH) functional ability score.
  
  
  RESULTS
  A total of 4700 RA adalimumab-treated patients were included in this analysis. Baseline disease activity increased with an increasing number of prior biologic agents and therapeutic response diminished. After 12 months of adalimumab therapy, DAS28 and FFbH scores showed improvements in all groups, but the group with 0 prior biologic agents had the best outcomes, while the group with ≥2 prior biologic agents had the worst. Clinical response (EULAR and DAS28-dcrit) and remission rates showed a similar pattern. Nevertheless, 44% to 67% of patients treated with ≥2 prior biologic agents achieved a clinical response. Multiple regression analyses identified prior biologic therapy as a significant negative predictor for response to therapy.
  
  
  CONCLUSIONS
  Treatment with adalimumab leads to decreases in disease activity and improvements in function. Improvements are most pronounced in patients with 0 or 1 prior biologic agent, but a substantial proportion of patients treated with ≥2 prior biologic agents experience significant benefit from adalimumab therapy.
authors.affiliation: Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Feuchtenberger
authors.affiliation: Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kleinert
authors.affiliation: Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany.
authors.forename: Eva-Christina
authors.initials: EC
authors.lastname: Scharbatke
authors.affiliation: Biostatistics, GKM Gesellschaft für Therapieforschung mbH, München, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Gnann
authors.affiliation: J.-W. Goethe-University of Frankfurt, Frankfurt am Main, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Behrens
authors.affiliation: AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Wittig
authors.affiliation: AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Greger
authors.affiliation: Schwerpunkt Rheumatologie/Klinische Immunologie Medizinische Klinik und Poliklinik II, Universität Würzburg, Würzburg, Germany..
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Tony
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab