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Real-world clinical experience of biological disease modifying anti-rheumatic drugs in Malaysia rheumatoid arthritis patients

Rheumatology International volume 37, pages 1719–1725 (2017)Cite this article

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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Affiliations

  1. Rheumatology Unit, Department of Medicine, Hospital Pulau Pinang, Jalan Residensi, 10990, Georgetown, Penang, Malaysia

    Bee Eng Tan, Ai Lee Lim, Sow Lai Kan, Chong Hong Lim & Esther Ee Ling Tsang

  2. Rheumatology Unit, Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia

    Shereen Suyin Ch’ng

  3. Rheumatology Unit, Department of Medicine, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

    Nadiah Mohd Noor & Suk Chyn Gun

  4. Rheumatology Unit, Department of Medicine, Hospital Putrajaya, Putrajaya, Wilayah Persekutuan, Malaysia

    Nurulraziquin Mohd Jamid

  5. Rheumatology Unit, Department of Medicine, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia

    Cheng Lay Teh

  6. Department of Medicine, Hospital Queen Elizabeth I, Kota Kinabalu, Sabah, Malaysia

    Rachel Joshua Thundyil

  7. Department of Medicine, Hospital Sultan Ismail, Johor Baharu, Johor Bahru, Malaysia

    Yet Lin Loh

  8. Department of Medicine, Hospital Melaka, Malacca City, Melaka, Malaysia

    Hwee Cheng Chong

  9. Department of Medicine, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia

    Nurulraziquin Mohd Jamid

  10. Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia

    Swee Gaik Ong

  11. Department of Medicine, Hospital Raja Perempuan Zainab II, Kota Baharu, Kelantan, Malaysia

    Asmahan Mohamed Ismail

  12. Department of Medicine, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

    Rachel Joshua Thundyil

  13. Outcome and Evidence, Health and Value, Pfizer Malaysia Sdn Bhd, Kuala Lumpur, Wilayah Persekutuan, Malaysia

    Yvonne Y. L. Lee

Authors
  1. Bee Eng Tan
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  2. Ai Lee Lim
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  3. Sow Lai Kan
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  4. Chong Hong Lim
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  6. Shereen Suyin Ch’ng
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  7. Nadiah Mohd Noor
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  8. Nurulraziquin Mohd Jamid
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  9. Cheng Lay Teh
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  10. Rachel Joshua Thundyil
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  11. Yet Lin Loh
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  12. Hwee Cheng Chong
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  13. Swee Gaik Ong
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  14. Asmahan Mohamed Ismail
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  15. Yvonne Y. L. Lee
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  16. Suk Chyn Gun
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Corresponding author

Correspondence to Bee Eng Tan.

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Funding

No funding received for conduct of this study.

Conflict of interest

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.

Ethical approval

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

Keywords

  • Biologics
  • Efficacy
  • Real world
  • Rheumatoid arthritis
  • Safety
  • Southeast Asia