BACKGROUND: Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). METHODS: Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes. FINDINGS: We identified three types of treatment response trajectories: 'gradual responders' (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; 'rapid responders' (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; 'inadequate responders' (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p=0.03), and EULAR good or moderate responses at 1year was much higher among 'rapid responders' (p<0.001). INTERPRETATION: Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.

Department of Clinical Sciences Malmö Lund University Malmö Sweden; Department of Rheumatology Skåne University Hospital Malmö Sweden

Diakonhjemmet Hospital Oslo Norway

Hôpitaux Universitaires Paris Sud Université Paris Sud France

Hospital Clinic of Barcelona Spain

Institut de Rhumatologie de Montréal CHUM Canada

Institute of Rheumatology Prague Czech Republic

Rheumatology Research Unit Instituto de Medicina Molecular Lisbon Portugal

Rheumatology Unit University Hospital Bari Italy

Strasbourg University Hospital France

The DANBIO registry Rigshospitalet Glostrup University of Copenhagen Denmark; Department of Clinical Medicine University of Copenhagen Denmark

University Hospitals Geneva Switzerland

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