Tumour necrosis factor (TNF) alpha inhibitors have greatly improved disease control and quality of life in patients affected by rheumatoid arthritis; however, up to one third of patients fail to respond to these agents. Alternative non-TNF targeted biologics have also emerged, including rituximab, abatacept and tocilizumab. In this prospective population-based study, 3162 adults with rheumatoid arthritis were followed up to investigate the effectiveness of rituximab, abatacept and tocilizumab in the treatment of longstanding and refractory rheumatoid arthritis. The primary outcome measured was drug retention without failure at 24 months of follow-up. Researchers found that among patients that were using rituximab at the study onset, 68.6% of patients were still using rituximab without failure. In patients using abatacept, 39.3% of patients continued to use abatacept without failure. In patients using tocilizumab, 63.4% were using tocilizumab at the end of the follow-up period without failure. Average durations of survival without failure were 19.8 months for rituximab, 15.6 months for abatacept, and 19.1 months for tocilizumab. At 24 months of follow-up, more participants treated with rituximab or tocilizumab than with abatacept showed a good or moderate EULAR (European League Against Rheumatism) response. This study therefore shows that among patients with refractory rheumatoid arthritis, the use of rituximab and tocilizumab non-TNG targeted biologics was associated with greater improvements in outcomes when compared to abatacept.
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