title: Comparative effectiveness of treatment options after conventional DMARDs failure in rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the clinical effectiveness of two treatment strategies for active rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs): starting TNF inhibitors (TNFIs) or changing csDMARDs.
  
  
  METHODS
  We used two nationwide Korean RA registries for patient selection. TNFI users were selected from the BIOPSY, which is an inception cohort of RA patients starting biologic DMARDs. As a control group, we selected RA patients with moderate or high disease activity from the KORONA database whose treatment was changed to other csDMARDs. After comparing baseline characteristics between the two groups in either unmatched or propensity score matched cohorts, we compared potential differences in the 1-year remission rate as a primary outcome and changes in HAQ-DI and EQ-5D scores as secondary outcomes.
  
  
  RESULTS
  A total of 356 TNFI starters and 586 csDMARD changers were identified from each registry as unmatched cohorts, and 294 patients were included in the propensity score matched cohort. In the intention-to-treat analysis, TNFI starters had higher 1-year remission rates than csDMARD changers in both unmatched (19.1 vs. 18.4%, p < 0.01) and matched cohorts (19.7 vs. 15.0%, p < 0.01). In per protocol analysis, TNFI starters had much higher remission rates in unmatched (37.2 vs. 28.0%, p = 0.04) and matched cohorts (35.4 vs. 19.1%, p = 0.04). However, in matched cohorts, no significant differences were observed between two groups in HAQ-DI and EQ-5D scores.
  
  
  CONCLUSIONS
  We compared the clinical effectiveness of the two treatment strategies for active RA refractory to csDMARDs. TNFI starters showed higher 1-year remission rates than csDMARD changers.
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Yoon-Kyoung
authors.initials: YK
authors.lastname: Sung
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Dam
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Chan-Bum
authors.initials: CB
authors.lastname: Choi
authors.affiliation: Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Soyoung
authors.initials: S
authors.lastname: Won
authors.affiliation: Guri Hospital, Hanyang University, Guri, South Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Bang
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Hoon-Suk
authors.initials: HS
authors.lastname: Cha
authors.affiliation: School of Medicine, Catholic University of Daegu, Daegu, South Korea.
authors.forename: Jung-Yoon
authors.initials: JY
authors.lastname: Choe
authors.affiliation: Dong-A University Hospital, Busan, South Korea.
authors.forename: Won Tae
authors.initials: WT
authors.lastname: Chung
authors.affiliation: Kyung Hee University Hospital, Seoul, South Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.
authors.forename: Jae-Bum
authors.initials: JB
authors.lastname: Jun
authors.affiliation: Ajou University Hospital, Suwon, South Korea.
authors.forename: Hyoun Ah
authors.initials: HA
authors.lastname: Kim
authors.affiliation: Jeju National University Hospital, Jeju, South Korea.
authors.forename: Jinseok
authors.initials: J
authors.lastname: Kim
authors.affiliation: School of Medicine, Catholic University of Daegu, Daegu, South Korea.
authors.forename: Seong-Kyu
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Guri Hospital, Hanyang University, Guri, South Korea.
authors.forename: Hye-Soon
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jaejoon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Ewha Womans University Mokdong Hospital, Seoul, South Korea.
authors.forename: Jisoo
authors.initials: J
authors.lastname: Lee
authors.affiliation: Chonnam National University Medical School and Hospital, Gwangju, South Korea.
authors.forename: Shin-Seok
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Dong-A University Hospital, Busan, South Korea.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Kyung Hee University Hospital, Seoul, South Korea.
authors.forename: Yeon-Ah
authors.initials: YA
authors.lastname: Lee
authors.affiliation: Soonchunhyang University Cheonan Hospital, Cheonan, South Korea.
authors.forename: Seong-Su
authors.initials: SS
authors.lastname: Nah
authors.affiliation: Ajou University Hospital, Suwon, South Korea.
authors.forename: Chang-Hee
authors.initials: CH
authors.lastname: Suh
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Yoo
authors.affiliation: Inje University Ilsan Paik Hospital, Goyang, South Korea.
authors.forename: Bo Young
authors.initials: BY
authors.lastname: Yoon
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 04763, South Korea. scbae@hanyang.ac.kr.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea. scbae@hanyang.ac.kr.
authors.forename: Sang Cheol
authors.initials: SC
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; 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*; D016022:Case-Control Studies; D057186:Comparative Effectiveness Research; D016208:Databases, Factual; D004185:Disability Evaluation; D057915:Drug Substitution; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012074:Remission Induction; D056910:Republic of Korea; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF drugs; DMARDs; HAQ; Quality of life; Rheumatoid arthritis