Disease Burden, Patient Experiences, and Unmet Needs in Those With Rheumatoid Arthritis Initiating a Third Advanced Therapy: Insights From 20 Years of Real‐World Data

OBJECTIVE: Despite advances in rheumatoid arthritis (RA) treatment, a considerable proportion of patients exhibit refractory disease, prompting the need for a comprehensive understanding of refractory RA. We aimed to analyze the burden and patient experiences associated with initiation of a third biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (BT3-RA) in a large observational cohort. METHODS: Data were obtained from participants with RA in the FORWARD Databank from 1999 to 2019. Participants, stratified into BT3-RA and a comparator BT1-RA (first initiation of a b/tsDMARD) cohorts, were matched based on key demographic and disease-specific parameters. Demographics, patient-reported outcomes (PROs), comorbidities, and health care interactions were assessed at initiation of first advanced therapy and at the time of meeting BT3-RA criteria. RESULTS: After matching, 1,384 participants were included in the study (692 each for BT3-RA and BT1-RA). The BT3-RA cohort had worse PROs, greater comorbidity burden, and lower health satisfaction than BT1-RA controls. Those with BT3-RA had significantly higher odds of having a greater number of rheumatology visits in the previous six months than controls (>4 visits, 0-2 visit reference, odd ratio [OR] 3.8 [95% confidence interval (CI) 2.7-5.4], P < 0.001; 3-4 visits, 0-2 visit reference, OR 1.9 [95% CI 1.5-2.5]; P < 0.001). Those with BT3-RA also had higher odds of concomitant glucocorticoid use (OR 1.5 [95% CI 1.2-2.0], P < 0.001) and gastrointestinal disorders (OR 1.5 [95% CI 1.1-1.9], P < 0.01). CONCLUSION: Exposure to three advanced RA therapies was associated with significant disease burden and unmet health care needs. These findings underscore the importance of well-defined refractory criteria and the need for further investigation into this RA phenotype to identify targeted treatment strategies and ultimately improve outcomes.