What factors can make a patient less likely to respond to bDMARD therapy? Can two biologic agents be used together?
Recent reports suggest that 5% to 10% of patients will fail three or more bDMARDs used to treat their underlying rheumatic disease. These patients are defined as being bDMARD-resistant. The most important factor is to ensure the patient is compliant in taking the bDMARD. Other factors contributing to bDMARD resistance include obesity and smoking, which reduce the effectiveness of many bDMARDs. Younger age, female sex, and high disease activity scores are also factors predicting nonresponse. In patients with a partial response to bDMARDs, it may be tempting to combine two biologic agents. This should not be done due to an increased risk of serious infections.