title: Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study.
abstract: BACKGROUND
  Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD).
  
  
  METHODS
  Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes.
  
  
  RESULTS
  We identified three types of treatment response trajectories: 'gradual responders' (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; 'rapid responders' (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; 'inadequate responders' (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p=0.03), and EULAR good or moderate responses at 1year was much higher among 'rapid responders' (p<0.001).
  
  
  CONCLUSIONS
  Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.
authors: University Hospitals Geneva, Switzerland. Electronic address: Delphine.Courvoisier@hcuge.ch.
authors: D S
authors: DS
authors: Courvoisier
authors: University Hospitals Geneva, Switzerland.
authors: D
authors: D
authors: Alpizar-Rodriguez
authors: Strasbourg University Hospital, France.
authors: J E
authors: JE
authors: Gottenberg
authors: Hospital Clinic of Barcelona, Spain.
authors: M V
authors: MV
authors: Hernandez
authors: Rheumatology Unit, University Hospital, Bari, Italy.
authors: F
authors: F
authors: Iannone
authors: Diakonhjemmet Hospital, Oslo, Norway.
authors: E
authors: E
authors: Lie
authors: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
authors: M J
authors: MJ
authors: Santos
authors: Institute of Rheumatology, Prague, Czech Republic.
authors: K
authors: K
authors: Pavelka
authors: Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
authors: C
authors: C
authors: Turesson
authors: Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, France.
authors: X
authors: X
authors: Mariette
authors: Institut de Rhumatologie de Montréal, CHUM, Canada.
authors: D
authors: D
authors: Choquette
authors: The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
authors: M L
authors: ML
authors: Hetland
authors: University Hospitals Geneva, Switzerland.
authors: A
authors: A
authors: Finckh
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D001685:Biological Factors / Q000627:therapeutic use*; D015415:Biomarkers; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors; D015415:Biomarkers
keywords: Abatacept; DAS28; Disease activity; Drug retention; Longitudinal data; Response rate; Rheumatoid arthritis