title: The usage of biological DMARDs and clinical remission of rheumatoid arthritis in China: a real-world large scale study.
abstract: The aims of this study are to characterize the biological disease-modifying antirheumatic drug (bDMARD) usage patterns in real-life and examine the remission rate of rheumatoid arthritis (RA) patients receiving bDMARDs in routine clinical practice in China. Consenting RA patients (≥18 years) from 15 teaching hospitals and receiving marketed bDMARDs were included. In total, 802 patients (81.3 % women, 49.0 ± 13.9 years) were included; 89.5 % were receiving a combination of bDMARDs and conventional synthetic DMARDs (csDMARDS), whereas 10.5 % were receiving bDMARD monotherapy. Etanercept (including Enbrel® and local brand Yi Sai Pu® and Qiangke®), tocilizumab, adalimumab, and infliximab were used by 66.6 %, 17.0 %, 7.5 %, and 6.6 % patients, respectively. Etanercept was used at a mean weekly dose of 38.2 ± 15.6 mg for 25.5 ± 47.0 weeks and tocilizumab at 94.5 ± 21.9 mg for 4.7 ± 7.5 weeks. Overall rate of remission was 12.6 %, 5.4 % , and 3.5 % based on DAS28, CDAI, and SDAI scores, respectively. Compared with patients receiving bDMARDs for <3 months, those receiving bDMARDs for ≥3 months exhibited significantly lower DAS28 scores (p < 0.0001), and a significantly higher proportion of patients who received bDMARDs for ≥12 months achieved the treatment goal (remission or low disease activity, 62.5 % vs. 18.3 %, p < 0.0001). Patients receiving combination therapy with csDMARDs exhibited lower DAS28 scores than patients receiving bDMARD monotherapy (4.3 vs. 4.8, p = 0.011). This large-scale real-world study showed that bDMARD usage patterns in routine clinical practice in China were in accordance with international guidelines for RA management despite the short treatment duration. Longer duration of bDMARD usage and combination therapy showed a favored outcome of RA.
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xi Zhi Men Street, Xicheng District, Beijing, 100044, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: An
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xi Zhi Men Street, Xicheng District, Beijing, 100044, People's Republic of China.
authors.forename: Tian
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai, China.
authors.forename: Dongyi
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Rheumatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xingjiang, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Rheumatology, Nanfang Hospital of Southern Medical University, Guangzhou, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Rheumatology and Immunology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Rheumatology, China-Japan Union Hospital of Jilin University, Changchun, China.
authors.forename: Liqi
authors.initials: L
authors.lastname: Bi
authors.affiliation: Department of Rheumatology, Sichuan Provincial People's Hospital, Sichuan, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital of Guangzhou Traditional Chinese Medicine University, Guangzhou, China.
authors.forename: Changsong
authors.initials: C
authors.lastname: Lin
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital of Xi'An Jiaotong University, Xi'an, China.
authors.forename: Lan
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Rheumatology, Peking University Third Hospital, Beijing, China.
authors.forename: Xiangyuan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Niansheng
authors.initials: N
authors.lastname: Yang
authors.affiliation: Department of Rheumatology, Peking University First Hospital, Beijing, China.
authors.forename: Zhuoli
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Rheumatology, Beijing Jishuitan Hospital, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Song
authors.affiliation: Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: Shanghai Roche Pharmaceuticals Ltd, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Shanghai Roche Pharmaceuticals Ltd, Shanghai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Bi
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xi Zhi Men Street, Xicheng District, Beijing, 100044, People's Republic of China. zgli99@aliyun.com.
authors.forename: Zhanguo
authors.initials: Z
authors.lastname: Li
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D002681:China; D003430:Cross-Sectional Studies; D000068800:Etanercept / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D018401:Sample Size; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D000069285:Infliximab; D000068879:Adalimumab; C502936:tocilizumab; D000068800:Etanercept
keywords: Biological; China; DMARD; Duration; Rheumatoid arthritis; Therapy