Effectiveness of biologics in Australian patients with rheumatoid arthritis: a large observational study: REAL

Dave Nicholls, Rina Barrett, Peter Button, Matt Truman, Paul Bird, Lynden Roberts, Kathleen Tymms, Geoffrey Littlejohn, Hedley Griffiths

Research output: Contribution to journalArticleResearchpeer-review


Background: The comparative effectiveness of biologic treatment regimens in a real world Australian population is unknown. Aim: To assess the effectiveness of biological disease-modifying anti-rheumatic drugs (bDMARD) as monotherapy or in combination with methotrexate and/or other conventional DMARD (cDMARD) for the treatment of rheumatoid arthritis (RA). Methods: A retrospective, non-interventional study was conducted that investigated the use of bDMARD in adult patients with RA in routine clinical practice. Data were extracted from the Optimising Patient Outcomes in Australian Rheumatology – Quality Use of Medicines Initiative database. Real-world effectiveness was measured using the 28-joint disease activity score (DAS28) and clinical disease activity index (CDAI) by treatment group at baseline, weeks 12 and 24. Results: A total of 2970 patients was included with a median (min–max) age of 60.0 (19.0–94.0) years and median (min–max) duration of RA before first bDMARD treatment of 6.0 (0.2–58.3) years. A total of 1177 patients received more than one bDMARD during the analysis period of 1 January 1997 to 15 August 2015. Patients had 4922 treatment ‘episodes’ (defined as a cycle of continuous individual bDMARD prescribing in a single patient). Patients received a mean (SD) of 1.7 (1.0) episodes of treatment with median (min–max) treatment duration of 0.7 (0–11.8) years; median treatment duration was higher with the first treatment episode. bDMARD were most commonly initiated in combination with methotrexate (73.9% of episodes) and least commonly as monotherapy (9.9% of episodes). Median (min–max) baseline DAS28 decreased from 5.3 (0–8.7) with the first bDMARD to 3.7 (0–8.8) with the second. Median baseline CDAI similarly decreased. Conclusions: Patients tended to persist longer on their first bDMARD treatment. bDMARD as monotherapy or in combination appear to be accepted treatment strategies in the real world.

Original languageEnglish
Pages (from-to)1185-1192
Number of pages8
JournalInternal Medicine Journal
Issue number10
Publication statusPublished - Oct 2018


  • biologic DMARD
  • monotherapy
  • persistence
  • rheumatoid arthritis

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