Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

BSRBR-RA Contributors Group, BRAGGSS Collaborators

doi:10.1093/rheumatology/kead261

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

BSRBR-RA Contributors Group, BRAGGSS Collaborators

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

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 (b ¼ 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.

Original language	English
Pages (from-to)	648-656
Number of pages	9
Journal	Rheumatology (United Kingdom)
Volume	63
Issue number	3
DOIs	https://doi.org/10.1093/rheumatology/kead261
Publication status	Published - 1 Mar 2024

Keywords

deprivation
index of multiple deprivation
RA
socioeconomic position
treatment response

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10.1093/rheumatology/kead261

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@article{22160d2d5af449a3ab8be52a8d207c7a,

title = "Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis",

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 (b ¼ 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.",

keywords = "deprivation, index of multiple deprivation, RA, socioeconomic position, treatment response",

author = "{BSRBR-RA Contributors Group, BRAGGSS Collaborators} and James Galloway and T. Price and P. Emery and A. Morgan and N. Williams and J. Isaacs and D. Walker and L. Kay and H. Foster and B. Thompson and M. Lee and C. Dowson and R. Williams and R. Hull and A. Thomas and E. Wong and C. Kelly and J. Hamilton and G. Wilson and S. Till and J. Boulton and C. Buckley and F. Clarke and J. Fordham and A. Paul and A. Hakim and S. Bhagat and C. Edwards and P. Ho and M. Allen and K. Chaudhuri and A. Jones and A. Gupta and I. Pande and R. Cooper and S. Rigby and S. Green and C. Dunne and M. Green and M. Quinn and A. Brown and C. Lawson and A. Bhalla and B. Bowness and W. Smith and K. Nelson and T. Kennedy and J. Nixon and M. Davis and D. Wright",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2024",

month = mar,

day = "1",

doi = "10.1093/rheumatology/kead261",

language = "English",

volume = "63",

pages = "648--656",

journal = "Rheumatology (United Kingdom)",

issn = "1462-0324",

publisher = "OXFORD UNIV PRESS",

number = "3",

}

TY - JOUR

T1 - Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

AU - BSRBR-RA Contributors Group, BRAGGSS Collaborators

AU - Galloway, James

AU - Price, T.

AU - Emery, P.

AU - Morgan, A.

AU - Williams, N.

AU - Isaacs, J.

AU - Walker, D.

AU - Kay, L.

AU - Foster, H.

AU - Thompson, B.

AU - Lee, M.

AU - Dowson, C.

AU - Williams, R.

AU - Hull, R.

AU - Thomas, A.

AU - Wong, E.

AU - Kelly, C.

AU - Hamilton, J.

AU - Wilson, G.

AU - Till, S.

AU - Boulton, J.

AU - Buckley, C.

AU - Clarke, F.

AU - Fordham, J.

AU - Paul, A.

AU - Hakim, A.

AU - Bhagat, S.

AU - Edwards, C.

AU - Ho, P.

AU - Allen, M.

AU - Chaudhuri, K.

AU - Jones, A.

AU - Gupta, A.

AU - Pande, I.

AU - Cooper, R.

AU - Rigby, S.

AU - Green, S.

AU - Dunne, C.

AU - Green, M.

AU - Quinn, M.

AU - Brown, A.

AU - Lawson, C.

AU - Bhalla, A.

AU - Bowness, B.

AU - Smith, W.

AU - Nelson, K.

AU - Kennedy, T.

AU - Nixon, J.

AU - Davis, M.

AU - Wright, D.

PY - 2024/3/1

Y1 - 2024/3/1

N2 - 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 (b ¼ 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.

AB - 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 (b ¼ 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.

KW - deprivation

KW - index of multiple deprivation

KW - RA

KW - socioeconomic position

KW - treatment response

UR - http://www.scopus.com/inward/record.url?scp=85175239687&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/kead261

DO - 10.1093/rheumatology/kead261

M3 - Article

C2 - 37267152

AN - SCOPUS:85175239687

SN - 1462-0324

VL - 63

SP - 648

EP - 656

JO - Rheumatology (United Kingdom)

JF - Rheumatology (United Kingdom)

IS - 3

ER -

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

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Keywords

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