1992: Burden of Pain for Patients in the CorEvitas^TM Rheumatoid Arthritis Registry

Joshua Baker¹, J Morel Symons², Jud C Janak³, Page Moore³, Elizabeth Kohl³, Bernice Gershenson³, Oksana Pugach³, Dave Webb⁴, Alan A Martin⁴, Didier Saurigny⁵ and Marguerite Bracher⁵, ¹University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, ²GlaxoSmithKline, Collegeville, PA, ³CorEvitas, LLC, Waltham, MA, ⁴GlaxoSmithKline, Brentford, United Kingdom, ⁵GlaxoSmithKline, Stevenage, United Kingdom

Background/Purpose: Pain is a hallmark symptom of RA that impacts patients' quality of life and informs therapeutic decisions that aim to reduce joint inflammation and associated pain. Even for patients on biologic/targeted synthetic (b/ts)DMARDs, pain can persist, and it is difficult to identify who will experience this persistent pain. The aim of this study was to describe baseline clinical and non-clinical characteristics of patients with RA initiating b/tsDMARDs, stratified by pain improvement or persistence.

Methods: Patients in the CorEvitas RA Registry with the following criteria were included: initiated a b/tsDMARD within 1 month of a CorEvitas visit from 1/1/2015 to 1/1/2020; had clinically meaningful baseline pain (Pain visual analog scale [VAS; 0–100 mm] >20); and a second Pain VAS at 6 (3–9) months follow-up. Patients were stratified by line of targeted therapy and baseline Pain VAS: mild (21–44 mm), moderate (45–74 mm), severe (≥75 mm). Improved pain was defined as a Pain VAS decrease from baseline of ≥70%, ≥50%, or ≥30% at 6 months. Persistent pain was defined as worsening or failure to improve. Within line of therapy and baseline pain categories, mean/proportional differences and 95% confidence intervals (CI) for patient characteristics were calculated for the three criteria of improved vs persistent pain.

Results: A total of 3287 patients were included: 26% mild, 40% moderate, 34% severe pain. Across all lines of therapy and baseline pain categories, ≥50% of patients reported persistent pain at 6 months (Figure). Among second/third+ b/tsDMARD initiators (n=2385), ~75% reported persistent pain (improvement < 50%). Among b/tsDMARD-naïve patients with severe baseline pain, more patients with persistent pain (improvement < 30%; n=140) vs improved pain (improvement ≥30%; n=140) had the following characteristics: Medicaid insurance (19% vs 6%; Δ=13%; 95% CI 5%–20%), current smoker (29% vs 16%; Δ=13%; 95% CI 3%–23%), history of fibromyalgia (20% vs 9%; Δ=11%; 95% CI 3%–19%), difficulty sleeping (67% vs 45%; Δ=22%; 95% CI 11%–33%), current opioid use (43% vs 30%; Δ=13%; 95% CI 2%–25%), and concomitant conventional DMARD therapy (43% vs 29%; Δ=14%; 95% CI 3%–25%). Among patients on second line of therapy with severe baseline pain, more patients with persistent pain (improvement < 30%; n=242) vs improved pain (improvement ≥30%; n=151) were more likely to report: history of hypertension (40% vs 29%; Δ=11%; 95% CI 1%–20%), history of fibromyalgia (21% vs 9%; Δ=12%; 95% CI 5%–18%), difficulty sleeping (52% vs 40%; Δ=12%; 95% CI 2%–22%), and current opioid use (53% vs 39%; Δ=14%; 95% CI 4%–25%).

Conclusion: This study highlights the persistent burden of pain for many patients with RA initiating b/tsDMARDs, regardless of baseline pain severity or line of therapy. Multidisciplinary treatment approaches to effectively manage RA pain are critical and targeted interventions with novel b/tsDMARDs remain promising. As persistent pain is associated with chronic opioid use, further research to identify risk factors may reduce opioid use for this population.

This GSK-funded study (213726) was sponsored by CorEvitas, LLC, with editorial support by Fishawack Indicia Ltd, funded by GSK.
Figure. Percent of patients with persistent pain failing to achieve ≥30%, ≥50%, and ≥70% improvement in pain 6 months post-initiation by line of therapy, stratified by baseline pain category
Disclosures: J. Baker, Bristol Myers Squibb, Pfizer, CorEvitas LLC, Burns-White, LLC, RediTrex; J. Symons, GlaxoSmithKline (GSK); J. Janak, CorEvitas LLC; P. Moore, None; E. Kohl, CorEvitas LLC; B. Gershenson, None; O. Pugach, CorEvitas LLC; D. Webb, GlaxoSmithKline (GSK); A. Martin, GlaxoSmithKline (GSK); D. Saurigny, GlaxoSmithKline (GSK); M. Bracher, GlaxoSmithKline (GSK).