The following is a summary of “Proportion of Patients With Rheumatoid Arthritis Achieving ACR20/50/70; Consistent Patterns of a 60/40/20 as Demonstrated by a Systematic Review and Meta-analysis,” published in the March 2023 issue of Rheumatology by Mokbel, et al.

For a systematic review and meta-analysis, researchers determined the proportion of rheumatoid arthritis (RA) patients achieving 20%, 50%, and 70% improvement in American College of Rheumatology (ACR20/50/70) responses when treated with biologic disease-modifying antirheumatic drugs (bDMARDs) after an inadequate response to methotrexate (MTX), and to examine whether the proportions of ACR20/50/70 responses followed a consistent pattern in two distinct patient groups: biologic-naive patients initiating bDMARD therapy after MTX failure, and biologic-irresponsive (IR) patients switching to a second bDMARD after the failure of the first bDMARD.

The study adhered to the Methodological Expectations for Cochrane Intervention Reviews (MECIR) standards. Two separate groups of randomized controlled trials were included: the first group comprised studies involving biologic-naive patients who received a bDMARD in addition to MTX compared to a placebo plus MTX group, while the second group consisted of biologic-IR patients who received a second bDMARD plus MTX following the failure of the first bDMARD, compared to a placebo plus MTX group. The primary outcome measure was the proportion of RA patients achieving ACR20/50/70 responses at 24 ± 6 weeks.

A total of 21 studies conducted between 1999 and 2017 were included in the analysis: 15 studies for the biologic-naive group and 6 studies for the biologic-IR group. Among the biologic-naive patients, the proportions of patients achieving ACR20/50/70 responses were 61.4% (95% CI, 58.7%–64.1%), 37.8% (95% CI, 34.8%–40.8%), and 18.8% (95% CI, 16.1%–21.4%), respectively. For the biologic-IR patients, the proportions of patients achieving ACR20/50/70 responses were 48.5% (95% CI, 42.2%–54.8%), 27.3% (95% CI, 21.6%–33.0%), and 12.9% (95% CI, 11.3%–14.8%), respectively.

The systematic review and meta-analysis demonstrated that the proportions of ACR20/50/70 responses to bDMARD therapy in RA patients followed a consistent pattern. Biologic-naive patients achieved ACR20/50/70 responses in approximately 60%, 40%, and 20% of cases, respectively, while biologic-IR patients achieved ACR20/50/70 responses in approximately 50%, 25%, and 12.5% of cases, respectively.

Source: journals.lww.com/jclinrheum/Abstract/2023/06000/The_Proportion_of_Patients_With_Rheumatoid.3.aspx