{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:21:22Z","timestamp":1767140482897,"version":"build-2238731810"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Rheumatol Int"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Approximately one-third of patients on biologic therapy for rheumatoid arthritis (RA) receive them as monotherapy. There are few head-to-head randomised control trials comparing biologics as monotherapy. Our aim was to compare the efficacy and persistence of multimodal biologic agents as monotherapy in biologic na\u00efve patients with RA in the real-world setting. A multicentre retrospective observational study was carried out comparing TNF inhibitors (TNFi), IL6 receptor inhibitor (IL6Ri) and CTLA-4 inhibitor (CTLA-4i) monotherapy in biologic na\u00efve RA patients. The primary study outcome was DAS28 score at 6, 12, and 18\u00a0months. 126 patients were enrolled; 98 patients (78%) were taking TNFi, 19 patients (15%) IL6Ri and 10 (8%) CTLA-4i with similar baseline characteristics of sex and age across groups. Patients in the CTLA-4i group were more often seropositive and had greater numbers of comorbidities. At 6 and 12\u00a0months, patients in the IL6Ri group had a lower DAS28 score compared to TNFi monotherapy. Those on CTLA-4i monotherapy also had a lower DAS28 score at 6\u00a0months than the TNFi group, although differences were lost by 12\u00a0months. Drug retention at 18\u00a0months was highest in the IL6Ri arm (68%) and CTLA-4i arm (80%) compared with only 55% in the TNFi group. Our findings support current guidance that IL6Ri should be considered in biologic na\u00efve patients requiring biologic monotherapy, but also indicated that CTLA-4i could be an option.<\/jats:p>","DOI":"10.1007\/s00296-020-04531-6","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T05:02:53Z","timestamp":1582261373000},"page":"1045-1049","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Biologic monotherapy in the biologic na\u00efve patient with rheumatoid arthritis (RA): results from an observational study"],"prefix":"10.1007","volume":"40","author":[{"given":"Rosalind","family":"Benson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sizheng Steven","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Goodson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rikki","family":"Abernethy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devesh","family":"Mewar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,2,21]]},"reference":[{"key":"4531_CR1","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.1136\/annrheumdis-2013-203485","volume":"72","author":"P Emery","year":"2013","unstructured":"Emery P, Sebba A, Huizinga TW (2013) Biologic and oral disease-modifying antirheumatic drug monotherapy in rheumatoid arthritis. Ann Rheum Dis 72:1897\u20131904","journal-title":"Ann Rheum Dis"},{"key":"4531_CR2","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1136\/annrheumdis-2013-204573","volume":"73","author":"JS Smolen","year":"2014","unstructured":"Smolen JS, Landewe R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73:492\u2013509","journal-title":"Ann Rheum Dis"},{"key":"4531_CR3","first-page":"689","volume":"56","author":"E Choy","year":"2017","unstructured":"Choy E, Aletaha D, Behrens F, Finckh A, Gomez-Reino J, Gottenberg J-E et al (2017) Monotherapy with biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Rheumatology 56:689\u2013697","journal-title":"Rheumatology"},{"key":"4531_CR4","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/S0140-6736(13)60250-0","volume":"381","author":"C Gabay","year":"2013","unstructured":"Gabay C, Emery P, van Vollenhoven R et al (2013) Tocilizumab monotherapy versus adalimumab monotherapy for treat ment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. Lancet 381:1541\u20131550","journal-title":"Lancet"},{"key":"4531_CR5","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1136\/annrheumdis-2016-210310","volume":"76","author":"GR Burmester","year":"2017","unstructured":"Burmester GR, Lin Y, Patel R et al (2017) Efficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): a randomised, double-blind, parallel-group phase III trial. Ann Rheum Dis 76:840\u2013847","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"4531_CR6","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/EDE.0000000000000627","volume":"28","author":"K Yoshida","year":"2017","unstructured":"Yoshida K, Hern\u00e1ndez-D\u00edaz S, Solomon DH, Jackson JW, Gagne JJ, Glynn RJ, Franklin JM (2017) Matching weights to simultaneously compare three treatment groups: comparison to three-way matching. Epidemiology 28(3):387\u2013395","journal-title":"Epidemiology"},{"key":"4531_CR7","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1136\/annrheumdis-2013-203843","volume":"73","author":"M Schiff","year":"2014","unstructured":"Schiff M, Weinblatt ME, Valente R et al (2014) Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: two-year efficacy and safety findings from AMPLE trial. Ann Rheum Dis 73:86\u201394","journal-title":"Ann Rheum Dis"},{"issue":"12","key":"4531_CR8","first-page":"2156","volume":"54","author":"TS J\u00f8rgensen","year":"2015","unstructured":"J\u00f8rgensen TS, Kristensen LE, Christensen R, Bliddal H, Lorenzen T et al (2015) Effectiveness and drug adherence of biologic monotherapy in routine care of patients with rheumatoid arthritis: a cohort study of patients registered in the Danish biologics registry. Rheumatology 54(12):2156\u20132165","journal-title":"Rheumatology"},{"issue":"4","key":"4531_CR9","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1007\/s10067-015-2879-0","volume":"34","author":"M Backhaus","year":"2015","unstructured":"Backhaus M, Kaufmann J, Richter C, Wassenberg S, Roske AE et al (2015) Comparison of tocilizumab and tumour necrosis factor inhibitors in rheumatoid arthritis: a retrospective analysis of 1603 patients managed in routine clinical practice. Clin Rheumatol 34(4):673\u2013681","journal-title":"Clin Rheumatol"},{"issue":"2","key":"4531_CR10","doi-asserted-by":"publisher","first-page":"e0169946","DOI":"10.1371\/journal.pone.0169946","volume":"12","author":"TS J\u00f8rgensen","year":"2017","unstructured":"J\u00f8rgensen TS, Turesson C, Kapetanovic M, Englund M, Turkiewicz A, Christensen R et al (2017) EQ-5D utility, response and drug survival in rheumatoid arthritis patients on biologic monotherapy: a prospective observational study of patients registered in the south Swedish SSATG registry. PLoS ONE 12(2):e0169946","journal-title":"PLoS ONE"}],"updated-by":[{"DOI":"10.1007\/s00296-020-04556-x","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T00:00:00Z","timestamp":1585785600000}}],"container-title":["Rheumatology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-020-04531-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00296-020-04531-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00296-020-04531-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T20:37:57Z","timestamp":1613767077000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00296-020-04531-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,21]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["4531"],"URL":"https:\/\/doi.org\/10.1007\/s00296-020-04531-6","relation":{},"ISSN":["0172-8172","1437-160X"],"issn-type":[{"value":"0172-8172","type":"print"},{"value":"1437-160X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,21]]},"assertion":[{"value":"24 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2020","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"In the original article, the corresponding author\u2019s given name and middle name were interchanged.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Authors R Benson, S Zhao, N Goodson, R Abernethy and D Mewar have no conflicts of interests to declare. Theresa Barnes undertook advisory boards for Roche and Abbvie and has delivered talks for Roche, Abbvie, Pfizer, UCB and BMS.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"Ethical approval for this retrospective study was sought and granted by IRAS\u2014reference number 208049 with HRA approval. The study was performed in accordance with the ethical standards of the institution or practice at which the studies were conducted.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}