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No real difference spotted in RA drug efficacy following csDMARDs

Key clinical point: No significant differences in outcomes occurred in RA patients treated with a tumor necrosis factor inhibitor (TNFi) or a non-TNFi following treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), supporting the value of clinical judgement and patient preferences.

Major finding: The response rate for achieving low disease activity (CDAI score of 10 or less) was 39.9% in the TNFi patients and 41.6% in the non-TNFi patients (P = 0.87).

Study details: The data come from a comparative effectiveness study of 4,816 individuals from the Corrona RA Registry, a large United States health care registry of RA patients aged 18 years and older; endpoints included measures of several clinical outcomes at 1 year after treatment with a TNFi or non-TNFi following csDMARDs.

Disclosures: The current study was sponsored by Corrona LLC and the analysis was funded by Sanofi and Regeneron. The Corrona Registry has been supported in the past 2 years by many pharmaceutical companies, including Regeneron. Several authors are employed or were formerly employed by Regeneron or Sanofi.


This study using the CORRONA registry data, evaluated the effectiveness of TNF inhibitors vs other non-TNFi biologics and targeted synethetic DMARDs as first line therapy after conventional synthetic DMARDs. Adult patients with RA, naïve to bDMARDs and tsDMARDs, and a baseline CDAI of > 2.8 were evaluated for disease activity, functional status, and anemia 1 year (+/- 3 months) after initiation of a TNFi or non-TNFi (abatacept, rituximab, tocilizumab, anakinra, or tofacitinib). There were no differences between patients treated with TNFi or non-TNFi other than a small difference in incidence of anemia factoring the TNFi treatment group. Despite the origin of the data from a registry cohort, this study is useful in evaluating different RA treatments due to the paucity of head-to-head prospective trials for bDMARDs and tsDMARDs. The results confirm findings from systematic reviews of RA trials, and support relying on providers’ clinical judgment and patients’ preferences in shared decision-making.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University


Pappas DA et al. Ann Rheum Dis. 2020 July 21. doi:10.1136/ annrheumdis-2020-217209.