Socioeconomic and behavioral associations with biologic therapy outcomes in rheumatoid arthritis: a prospective cohort study

Abstract Objective To evaluate whether socioeconomic factors, psychological distress, and medication adherence are independently associated with 12‑month remission and biologic persistence in RA patients receiving biologic therapy. Methods This prospective cohort study enrolled 135 patients with moderate‑to‑severe RA (84.4% female; mean age 47.2 years) initiating or continuing biologic therapy. Baseline assessments included socioeconomic status (residence, income, and education); clinical measures (DAS28-CRP, HAQ-DI, and CRP); psychological status (PHQ-9 and PSS-10); medication adherence (MMAS-8); smoking; and physical activity. Treatment status at baseline (new initiation vs. continuation) was recorded as a covariate. The primary outcome was 12‑month DAS28‑CRP remission (< 2.6); the secondary outcome was biologic drug survival at 12 months, defined as the continued use of any biologic agent without treatment discontinuation, allowing switches between different biologic agents. Multivariable logistic regression and Kaplan‑Meier analyses were performed. Results At 12 months, 57.8% ( n = 78) achieved remission, and 83.7% ( n = 113) demonstrated biologic drug survival (71.9% continued initial therapy; 11.9% switched; 16.3% discontinued). In multivariable analysis adjusted for disease activity and treatment type, higher baseline adherence was independently associated with remission (OR 2.44 per MMAS point; 95% CI 1.71–3.48; p < 0.001), alongside urban residence (OR 4.14; 95% CI 1.49–11.51; p = 0.006). Conversely, current/former smoking (OR 0.16; 95% CI 0.05–0.52; p = 0.002), higher baseline DAS28 (OR 0.22; 95% CI 0.09–0.56; p = 0.002), and depressive symptoms (OR 0.76 per PHQ‑9 point; 95% CI 0.65–0.89; p < 0.001) were associated with significantly lower remission odds. Drug survival was 98.0% in high adherers versus 62.0% in low adherers (log‑rank p < 0.001). Conclusion In this RA cohort, socioeconomic deprivation, poor baseline adherence, smoking, and depression were independently associated with poor biologic outcomes, with effect sizes comparable to those of traditional clinical markers. Biologic drug survival was substantially superior among patients with good adherence compared with those with poor adherence.