Clinical outcomes of molecular-targeted therapies for rheumatoid arthritis: comparison between orthopaedic surgeons and rheumatologists in the multicenter retrospective ANSWER cohort - Report - MDSpire
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Clinical outcomes of molecular-targeted therapies for rheumatoid arthritis: comparison between orthopaedic surgeons and rheumatologists in the multicenter retrospective ANSWER cohort
Comparative Outcomes of Molecular-Targeted RA Treatments by Orthopaedic Surgeons vs Rheumatologists
Overview
This multicenter retrospective study from Japan compared treatment retention and patient characteristics in rheumatoid arthritis (RA) patients receiving biologic DMARDs or JAK inhibitors managed by orthopaedic surgeons versus rheumatologists. Adjusted analyses revealed differences in baseline profiles and treatment patterns, with implications for clinical management in dual-care settings.
Background
Biologic DMARDs and Janus kinase inhibitors have transformed RA management by improving disease control and long-term outcomes. In Japan, a unique dual-care system exists where both rheumatologists and rheumatology-oriented orthopaedic surgeons provide pharmacological treatment for RA, unlike most countries where rheumatologists primarily manage RA pharmacotherapy. Treatment retention is a key measure reflecting drug safety, efficacy, and tolerability. This study aimed to compare treatment retention and patient characteristics between these two clinical settings using data from the ANSWER cohort.
Data Highlights
Parameter
Orthopaedic Surgeon Group
Rheumatologist Group
Statistical Test
Baseline Age
Reported (median, IQR)
Reported (median, IQR)
Mann–Whitney U test
Disease Duration
Reported (median, IQR)
Reported (median, IQR)
Mann–Whitney U test
Concomitant MTX Use
Percentage
Percentage
Chi-square test
Concomitant GC Use
Percentage
Percentage
Chi-square test
Drug Retention (Kaplan–Meier)
Survival curves generated
Survival curves generated
Adjusted Cox regression
CDAI Scores at 1, 3, 6, 12 months
Mean values
Mean values
Mann–Whitney U test
CDAI Remission Rates
Percentages
Percentages
Chi-square test
Key Findings
Patients treated by orthopaedic surgeons and rheumatologists showed significant differences in baseline characteristics, including disease duration and concomitant medication use.
Adjusted analyses accounted for confounders such as age, sex, serological status, comorbidities, and drug class to compare treatment retention.
Treatment retention differed between the two groups when stratified by reasons for discontinuation: ineffectiveness, toxic adverse events, non-toxic reasons, and remission.
Disease activity control, measured by CDAI scores and remission rates at multiple time points, was compared and showed variations between groups.
All treating physicians were board-certified rheumatology specialists, ensuring comparable expertise despite specialty differences.
Clinical Implications
In clinical practice, understanding differences in patient profiles and treatment retention between orthopaedic surgery and rheumatology clinics can guide personalized RA management in settings with dual-care systems. Close monitoring of treatment effectiveness and adverse events remains essential regardless of the managing specialty. These findings support collaborative care models and highlight the importance of standardized treatment protocols across specialties.
Conclusion
This study provides valuable insights into the comparative clinical outcomes of molecular-targeted RA therapies managed by orthopaedic surgeons versus rheumatologists in Japan. Adjusted analyses underscore the need to consider patient and treatment heterogeneity when evaluating treatment retention and disease control in diverse clinical settings.
References
Tanaka et al. 2024 -- Comparative Analysis of Clinical Outcomes from Molecular-Targeted Treatments for Rheumatoid Arthritis
