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dc.contributor.authorNovella-Navarro, Marta
dc.contributor.authorPlasencia, Chamaida
dc.contributor.authorTornero, Carolina
dc.contributor.authorNavarro-Compán, Victoria
dc.contributor.authorCabrera-Alarcón, José Luis 
dc.contributor.authorPeiteado-López, Diana
dc.contributor.authorNuño, Laura
dc.contributor.authorMonjo-Henry, Irene
dc.contributor.authorFranco-Gómez, Karen
dc.contributor.authorVillalba, Alejandro
dc.contributor.authorBalsa, Alejandro
dc.identifier.citationArthritis Res Ther. 2020; 22(1):284es_ES
dc.description.abstractBiological therapies have improved the clinical course and quality of life of rheumatoid arthritis (RA) patients. Despite the availability and effectiveness of these treatments, some patients experience multiple failures to biologic disease-modifying antirheumatic drugs (bDMARDs), constituting a particular challenge to clinicians. This study aims to determine the percentage of rheumatoid arthritis (RA) patients who fail to respond to subsequent bDMARDs, describe their characteristics, and identify specific baseline and early features during the first bDMARD as possible predictors of consecutive multiple bDMARD failure. This is a longitudinal study involving RA patients from the prospective biological cohort drawn from the La Paz University Hospital RA Registry (RA-Paz), starting a bDMARD during the years 2000 to 2019. Patients who presented insufficient response (due to primary or secondary inefficacy) to at least three bDMARDs or two bDMARDs with different mechanism of action were considered multi-refractory (MR-patients). Patients who achieved low disease activity or remission (by DAS-28) with the first bDMARD and maintained this over a follow-up period of at least 5 years were considered non-refractory (NR-patients). A total of 41 out of 402 (10%) patients were MR-patients and 71 (18%) NR-patients. In the multivariate analysis, the presence of erosions, younger age, higher baseline DAS-28 and mostly achieving delta-DAS < 1.2 after 6 months of the first bDMARD (OR 11.12; 95% CI 3.34-26.82) were independently associated with being MR-patients to bDMARDs. In our cohort, 10% of patients with RA were observed to have multi-refractoriness to bDMARDs. This study supports the contention that younger patients with erosive disease and especially the early absence of clinical response to the first bDMARDs are predictors of multi-refractoriness to consecutive biologics. Hence, patients with these characteristics should be monitored more closely and may benefit from personalized treatments.es_ES
dc.description.sponsorshipThis work was supported by the Fundación Española de Reumatología (FER) and Instituto de Salud Carlos III (ISCIII), Ministry of Health, Spain (Juan Rodés research contract to MNN).es_ES
dc.publisherBioMed Central (BMC) es_ES
dc.titleClinical predictors of multiple failure to biological therapy in patients with rheumatoid arthritis.es_ES
dc.typejournal articlees_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.identifier.journalArthritis research & therapyes_ES
dc.repisalud.orgCNICCNIC::Unidades técnicas::Bioinformáticaes_ES
dc.rights.accessRightsopen accesses_ES

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