The definition continues to evolve as newer agents are added to the armamentarium.
Reference1. Buch MH. Defining refractory rheumatoid arthritis. Ann Rheum Dis. 2018 Mar 27. pii: annrheumdis-2017-212862. doi: 10.1136/annrheumdis-2017-212862. [Epub ahead of print]
Maya Buch from the Leeds Institute in the UK defines refractory rheumatoid arthritis (RA) and suggests an initial approach as well as continued evaluation of patients who fail to respond to biologic disease-modifying antirheumatic drug (bDMARD) therapy.1
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Registry data show 5% failing at least a third bDMARD class because of inefficacy and/or toxicity.
Randomized trials have demonstrated 50%–30%–10% ACR 20, 50, and 70 responses, respectively, in tumor necrosis factor inhibitor–inadequate response (TNFi-IR) studies.
Refractory disease that is not a consequence of anti-drug antibody (ADA) and/or biomechanical factors may represent disease subgroups with distinct immunopathological drivers.