Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France

Anna Molto; Laurent Arnaud; Mélanie Chartier; Arnaud Panes; Pauline Lemeille; Bruno Fautrel

doi:10.1016/j.jbspin.2025.106023

Treatment sequences of biological and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis: A nationwide population-based study in France

Joint Bone Spine. 2025 Dec 22;93(3):106023. doi: 10.1016/j.jbspin.2025.106023. Online ahead of print.

Authors

Anna Molto¹, Laurent Arnaud², Mélanie Chartier³, Arnaud Panes⁴, Pauline Lemeille⁴, Bruno Fautrel⁵

Affiliations

¹ Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Paris, France; Rheumatology department, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris France. Electronic address: Anna.molto@aphp.fr.
² Service de Rhumatologie, CHU de Strasbourg, INSERM UMRS-1109, 1, place de l'hôpital, BP 426, 67091 Strasbourg Cedex, France.
³ Bristol Myers Squibb, HEOR France Department, 3, Rue Joseph-Monier, BP 325, 92506 Rueil-Malmaison cedex, France.
⁴ Heva, 186, avenue Thiers, 69465 Lyon Cedex 06, France.
⁵ Sorbonne Université-Assistance Publique Hôpitaux de Paris, Service de Rhumatologie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, 75013 Paris, France; INSERM UMRS 1136, Institut Pierre-Louis d'Épidémiologie et Santé Publique, 75013 Paris, France.

PMID: 41443535
DOI: 10.1016/j.jbspin.2025.106023

Abstract

Objectives: The study aimed to describe nationwide treatment sequences in French patients with rheumatoid arthritis (RA) initiating a first biological or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD).

Methods: This analysis is based on the French National Health Claims Database (SNDS), covering over 67 million people. Patients with RA (ICD-10 codes M05, M060, M068 or M069) and ≥2 b/tsDMARD dispensings from January 1, 2014 to December 31, 2019 were included, and followed until December 31, 2020 or death. Differences in patients characteristics at each b/tsDMARD initiation were tested with Mann Whitney U tests and χ² tests.

Results: Overall, 26 478 patients were identified (mean (SD) age 57.0 years (±14.4)) including 70.9% females. The most frequent first-line of b/tsDMARD were TNF inhibitors (TNFi) (62.6%), followed by abatacept (CTLA4-Ig) (12.0%), rituximab (11.0%), IL-6R inhibitors (IL-6Ri) (10.0%), and JAK inhibitors (JAKi) (3.9%). The mean (SD) follow-up duration was 3.8 years (±1.7 years,), for a total of 100 332 person-years. Throughout the study period, 12,662 patients (47.8%) maintained their first b/tsDMARD, while 7531 (28.4%) switched to a second b/tsDMARD, and 3046 (11.1%) to a third b/tsDMARD, after a mean duration of 54.1 (±34.0), 31.9 (±27.8) and 25.9 (±22.2) months, respectively. In terms of mode of action associated profiles, the main discrepancies were age, higher in CD20i and LT modulator patients, and comorbidities, more prevalent in CD20i treated patients.

Conclusion: In this nation-wide analysis of 26 478 patients, TNFi was the most frequently dispensed first-line b/tsDMARD, with LT modulators and IL-6i preferred in second-line therapy.

Keywords: Anti-CD20 monoclonal antibodies; Anti-interleukin 6; French national healthcare database; Janus kinase inhibitors; Lymphocyte T modulators; Prevalence; SNDS; Tumour necrosis factor inhibitors.