Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis
Author:
Zhao Sizheng Steven1ORCID, Rogers Kira2, Kearsley-Fleet Lianne1ORCID, Watson Kath1, Bosworth Ailsa3, Galloway James4, Verstappen Suzanne1, Plant Darren5ORCID, Barton Anne56ORCID, Hyrich Kimme L16ORCID, Humphreys Jenny H16, Gaston H, Mulherin D, Price T, Sheeran T, Chalam V, Baskar S, Emery P, Morgan A, Buch M, Bingham S, O&hx2019;Reilly S, Badcock L, Regan M, Ding T, Deighton C, Summers G, Raj N, Stevens R, Williams N, Isaacs J, Platt P, Walker D, Kay L, Griffiths B, Ng W -F, Peterson P, Lorenzi A, Foster H, Friswell M, Thompson B, Lee M, Griffiths I, Hassell A, Dawes P, Dowson C, Kamath S, Packham J, Shadforth M, Brownfield A, Williams R, Mukhtyar C, Harrison B, Snowden N, Naz S, Ledingham J, Hull R, McCrae F, Thomas A, Young Min S, Shaban R, Wong E, Kelly C, Heycock C, Hamilton J, Saravanan V, Wilson G, Bax D, Dunkley L, Akil M, Tattersall R, Kilding R, Till S, Boulton J, Tait T, Bukhari M, Halsey J, Ottewell L, Buckley C, Situnayake D, Carruthers D, Grindulis K, Khatack F, Elamanchi S, Raza K, Filer A, Jubb R, Abernathy R, Plant M, Pathare S, Clarke F, Tuck S, Fordham J, Paul A, Bridges M, Hakim A, O&hx2019;Reilly D, Rajagopal V, Bhagat S, Edwards C, Prouse P, Moitra R, Shawe D, Bamji A, Klimiuk P, Bowden A, Mitchell W, Bruce I, Barton AORCID, Gorodkin R, Ho P, Hyrich KORCID, Dixon W, Rai A, Kitas G, Erb N, Klocke R, Douglas K, Pace A, Sandhu R, Whallett A, Birrell F, Allen M, Chaudhuri K, Chattopadhyay C, McHale J, Jones A, Gupta A, Pande I, Gaywood I, Lanyon P, Courtney P, Doherty M, Chinoy H, O&hx0027;Neill T, Herrick A, Jones A, Cooper R, Bucknall R, Marguerie C, Rigby S, Dunn N, Green S, Al-Ansari A, Webber S, Hopkinson N, Dunne C, Quilty B, Szebenyi B, Green M, Quinn M, Isdale A, Brown A, Saleem B, Samanta A, Sheldon P, Hassan W, Francis J, Kinder A, Neame R, Moorthy A, Al-Allaf W, Taggart A, Fairburn K, McKenna F, Green M, Gough A, Lawson C, Piper M, Korendowych E, Jenkinson T, Sengupta R, Bhalla A, McHugh N, Bond D, Luqmani R, Bowness B, Wordsworth P, David J, Smith W, Mewar D, Tunn E, Nelson K, Kennedy T, Nixon J, Woolf A, Davis M, Hutchinson D, Endean A, Coady D, Wright D, Morley C, Raftery G, Bracewell C, Kidd L, Abbas I, Filer C, Kallarackal G, ,
Affiliation:
1. Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre , Manchester, UK 2. Manchester Medical School, The University of Manchester , Manchester, UK 3. National Rheumatoid Arthritis Society (NRAS) , Maidenhead, UK 4. Centre of Rheumatic Diseases, School of Immunology & Microbial Sciences, King’s College London , London, UK 5. Centre for Genetics and Genomics Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre , Manchester, UK 6. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust , Manchester, UK
Abstract
Abstract
Objective
To investigate the association between socioeconomic deprivation and outcomes following TNF inhibitor (TNFi) treatment.
Methods
Individuals commencing their first TNFi in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA) and Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS) cohort were included. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation and categorized as 20% most deprived, middle 40% or 40% least deprived. DAS28-derived outcomes at 6 months (BSRBR-RA) and 3 months (BRAGGSS) were compared using regression models with the least deprived as referent. Risks of all-cause and cause-specific drug discontinuation were compared using Cox models in the BSRBR-RA. Additional analyses adjusted for lifestyle factors (e.g. smoking, BMI) as potential mediators.
Results
16 085 individuals in the BSRBR-RA were included (mean age 56 years, 76% female), of whom 18%, 41% and 41% were in the most, middle and least deprived groups, respectively. Of 3459 included in BRAGGSS (mean age 57, 77% female), proportions were 22%, 36% and 41%, respectively. The most deprived group had 0.3-unit higher 6-month DAS28 (95% CI 0.22, 0.37) and were less likely to achieve low disease activity (odds ratio [OR] 0.76; 95% CI 0.68, 0.84) in unadjusted models. Results were similar for 3-month DAS28 (β = 0.23; 95% CI 0.11, 0.36) and low disease activity (OR 0.77; 95% CI 0.63, 0.94). The most deprived were more likely to discontinue treatment (hazard ratio 1.18; 95% CI 1.12, 1.25), driven by ineffectiveness rather than adverse events. Adjusted estimates were generally attenuated.
Conclusion
Socioeconomic deprivation is associated with reduced response to TNFi. Improvements in determinants of health other than lifestyle factors are needed to address socioeconomic inequities.
Funder
National Institute for Health Research (NIHR) Academic Clinical Lectureship NIHR Manchester Biomedical Research Centre British Society for Rheumatology (BSR) and the NIHR Manchester Biomedical Research Centre Abbvie Amgen Celltrion Healthcare Eli Lilly Galapagos Pfizer Samsung Bioepis Sanofi Hospira MSD Roche Sandoz Swedish Orphan Biovitrum UCB BSR and the University of Manchester University of Manchester
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Cited by
2 articles.
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