Abstract
The effect of biologic disease modifying anti-rheumatic drugs (bDMARDs) in treating rheumatoid arthritis (RA) in real-world clinical practice remains unknown in Southeast Asia. We aimed to assess the efficacy and safety of bDMARDs among Malaysian RA patients treated in routine clinical practice. A retrospective medical chart review of RA patients from 11 government hospitals were conducted from January 2003 to January 2014. A standardized questionnaire was used to abstract patient’s demographic, clinical and treatment data. Level of disease activity was measured by DAS28 collected at baseline, 3, 6 and 12 months. Three hundred and one patients were available for analysis, mean age 41 (SD, 10.8) years, mean RA duration 12.3 (SD, 6.9) years and 98% had history of two or more conventional-synthetic DMARDs. There were 467 bDMARD courses prescribed with mean bDMARDs duration use of 12.9 months (SD 14.7). Tumour necrosis factor alpha inhibitors were the most common prescribed bDMARDs (77.1%), followed by Tocilizumab (14.6%) and Rituximab (8.4%). We observed significant improvement in mean DAS28 values from baseline to 3, 6 and 12 months (p < 0.001). Overall, 16.9% achieved DAS28 remission at 6 months. A third (35.6%) of patients reported adverse events, three commonest being infections (46.5%), allergy (22.9%) and laboratory abnormalities (12.9%). 3.7% of our patients had tuberculosis. Biologic DMARDs were effective in treating RA in real-world practice in Malaysia, despite a lower remission rate compared to developed countries. Except for higher rates of tuberculosis, the AEs were similar to the published reports.
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Acknowledgements
The authors thank all the rheumatologists and rheumatology trainees who helped in the data collection in the participating MOH hospitals. We also thank the director general, Ministry of Health Malaysia for permission to publish this article.
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No funding received for conduct of this study.
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Author Yvonne Lee YL is an employee of Pfizer Malaysia. Author Bee Eng Tan, Ai Lee Lim, Sow Lai Kan, Chong Hong Lim, Esther Ee Ling Tsang, Shereen Suyin Ch’ng, Nadiah Mohd Noor, Nurulraziquin, Mohd Jamid, Cheng Lay Teh, Rachel Joshua Thundyil, Yet Lin Loh, Hwee Cheng Chong, Swee Gaik Ong, Asmahan Mohamed Ismail, and Suk Chyn Gun declare that they have no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Tan, B.E., Lim, A.L., Kan, S.L. et al. Real-world clinical experience of biological disease modifying anti-rheumatic drugs in Malaysia rheumatoid arthritis patients. Rheumatol Int 37, 1719–1725 (2017). https://doi.org/10.1007/s00296-017-3772-8
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DOI: https://doi.org/10.1007/s00296-017-3772-8