Overview
The project at a glance.
MDR RA is a European research project focused on people with rheumatoid arthritis whose disease does not respond to several standard treatments.
The project brings together leading rheumatology centres, data experts, and patient organisations across 12 countries to better understand why treatments fail and to design more personalised, effective care.
Aims
- Understand the clinical and molecular reasons why some people develop multi‑drug‑resistant rheumatoid arthritis.
- Use large existing cohorts and a new observational study to identify early warning signs of treatment resistance.
- Develop iCare‑RA, an AI‑supported care model that helps clinicians choose treatments more precisely.
- Test iCare‑RA in a real‑world clinical trial against current standard care.
- Evaluate long‑termhealth and economic effects, and create an open biomedical resource for futureresearch.
Partners
The MDR-RA consortium includes 18 academic centres, 3 small and medium-sized
enterprises, and patient organisations, including EULAR-PARE, working together across 12
European countries. This mix of clinical, scientific, digital, and patient expertise ensures that
results are both scientifically robust and relevant to everyday care.
Timeline & two-phase design text + graphic
- The project runs for 60 months. In the observational phase, MDR-RA analyses deeply characterised clinical and molecular datasets from more than 25,000 people with RA and builds a new observational cohort of patients with multi-drug-resistant RA.
- In the interventional phase, the team embeds the iCare-RA model into clinical practice and evaluates it in a prospective cluster trial, comparing iCare-supported care with current standard care.
Stakeholder
Solving multi-drug-resistant RA requires many perspectives. MDR-RA is designed as a co-created project, with patients, clinicians, researchers, data scientists, health economists, and policy stakeholders working side by side from the beginning.
Patients & Patient Research Partners (PRPs)
People living with RA are involved as partners, not just as study participants. PRPs help co-develop the iCare-RA model, advise on which outcomes matter, review patient materials, and bring lived experience into study design and decision-making.
Patient organisations
MDR-RA collaborates with 14 national patient organisations. They support recruitment and outreach, highlight unmet needs and care barriers, and help turn complex scientific results into information that patients and caregivers can understand and use.
Clinicians & healthcare professionals
Rheumatologists and other health professionals contribute to deep clinical phenotyping, design of real-world cohorts, and validation of iCare-RA. Their input ensures that new tools fit with everyday clinical workflows and existing treatment guidelines.
Researchers & data scientists
Academic and clinical researchers work with data scientists to integrate clinical records, imaging, molecular profiles, and patient-reported outcomes. Together they build and test AI models that can stratify patients and predict treatment responses.
Health economists
Health economists analyse costs and benefits of new care strategies and of the iCare-RA model. Their work produces evidence that is useful for payers and health authorities when deciding how to fund and scale new approaches.
Policy-relevant stakeholders and regulators
Policy experts and regulators are engaged to understand how MDR-RA results can feed into future guidelines, reimbursement decisions, and regulatory pathways for diagnostics and decision-support tools. Early dialogue helps anticipate barriers to adoption.
Why this stakeholder model matters
This structured stakeholder involvement improves the relevance and quality of the research, builds trust, and increases the chances that new models like iCare-RA will be adopted and sustained in real-world healthcare systems.
Expected Impact
MDR-RA targets an under-researched, high-burden form of rheumatoid arthritis.
By combining deep phenotyping, AI-driven modelling, and patient-centred design, the project aims to improve outcomes for individuals and reduce wasteful spending for health systems.
Better care for patients
- More precise identification of people at risk of treatment resistance and earlier ecognition of multi-drug-resistant RA.
- Reduced trial-and-error prescribing and faster access to effective therapies, helping to prevent long-term joint damage and disability.
- Care models that take into account pain, psychosocial factors, and quality of life, not only inflammation measures.
Economic and health-system impact
- Optimised use of expensive medicines and avoidance of ineffective treatments, with modelling suggesting potential savings of up to €10 billion and 1,500–2,000 disability-adjusted life years per year in Europe if MDR-RA care is improved at scale.
- Evidence to support payers and policymakers in deciding how to invest in precision rheumatology and integrated care pathways for RA.
Lasting tools and resources
- The iCare-RA model: a decision-support tool that can be refined and expanded beyond the project, helping clinicians match treatments to patient profiles.
- A unique MDR-RA biomedical resource and in-silico data legacy, including harmonised clinical, imaging, and multi-omic datasets made available under FAIR and open-science principles for future research and innovation.
The Challenge
Transforming Care for Rheumatoid Arthritis Patients with Multi-Drug Resistance
Rheumatoid Arthritis (RA) is the most common chronic inflammatory joint disease, affecting approximately 1% of adults worldwide—that's over 22 million people globally and 7 million in the EU alone. The societal burden is immense, with RA responsible for over 10,000 disability-adjusted life years (DALYs) and costing the EU an estimated €55 billion each year.
Despite significant advances in therapy, about one-third of RA patients are forced to give up work within five years of diagnosis—primarily because their disease does not respond to available treatments. This phenomenon, known as multi-drug resistance (MDR), leaves many patients facing disability, unemployment, and ongoing pain.
Our Mission: Tackling Multi-Drug Resistant RA
The MDR-RA project aims to revolutionize the way we understand and manage RA patients with multi-drug resistance.
Our objective is to:
- Identify the clinical and molecular phenotypes that lead to MDR in RA, allowing us to predict, prevent, or better manage resistance.
- Integrate cutting-edge molecular pathology with clinical, psychosocial, pain perception, and imaging data from existing clinical cohorts.
- Develop holistic, predictive models (iCare-RA) to support personalised treatment decisions and improve patient outcomes. Pioneering Research, Real-World Impact
MDR-RA will test the transformative potential of the iCare-RA model in a prospective randomised trial, comparing it directly with the current standard of care. We will also explore the future implementation of iCare-RA with early economic modelling to ensure sustainability and value for society.
Advancing Science and Care—Together
With a robust management and communication strategy, MDR-RA is committed to:
- Driving scientific discovery beyond the project’s duration
- Facilitating adoption by patients, healthcare professionals, policymakers, and regulators
- Shaping a future where no RA patient is left behind due to treatment resistance
Join us in transforming the future of Rheumatoid Arthritis care.
The Project
MDR-RA: Advancing Treatment for Drug-Resistant Rheumatoid Arthritis
MDR-RA is a European research initiative tackling multi-drug resistant rheumatoid arthritis—an under-researched, high-burden condition. The project aims to uncover the roots of treatment resistance and develop personalized care strategies to improve patient outcomes and redefine RA management.
By uniting academia and industry, MDR-RA drives innovation in diagnostics and therapies while building a lasting resource for future research. Through strong stakeholder engagement and targeted communication, the project ensures its breakthroughs reach clinicians, researchers, industry, and patients.
We are developing a robust data platform to harmonize and integrate diverse rheumatoid arthritis datasets, continuously updated with new data from ongoing studies. Using advanced analytics and data science, we ensure high-quality, standardised, and interoperable data—laying the foundation for predictive modelling and breakthrough MDR-RA research.
Objectives overview
The Output
Tackling Multi-Drug Resistant Rheumatoid Arthritis (MDR-RA)
Multi-Drug Resistant Rheumatoid Arthritis (MDR-RA) affects around 1.5 million people in the EU, with up to 50% experiencing treatment failure and annual costs soaring. The MDR-RA project offers a comprehensive, evidence-based response to this urgent healthcare challenge.
A Two-Phase MDR-RA Approach
Observational Phase
Interventional Phase
Holistic, AI-Enabled Decision Support
Powered by Collaboration from synergies from four Horizon Europe consortia to ensure robust integration and broader impact across the EU healthcare ecosystem.
A Two-Phase Approach
Observational Phase: Building the Foundation
In Phase 1, MDR-RA draws onEurope’s largest clinical and molecular data sets—over 25,000 RA patients from16 centres—to tackle treatment resistance.
Alongside this, we’re enrolling anew observational cohort of 80 RA patients and using specialised bio banks to deepen insights.
FocusAreas:
- Clinical & Imaging Models: Identifying early predictors of resistance.
- Molecular Subtypes: Defining biological profiles from blood and tissue samples.
- iCare-RAIntegration: Merging data into a predictive tool for personalised care.
This phase lays the scientific foundation for smarter, earlier intervention in RA.
Interventional Phase: Validating iCare-RA in Practice
Building on observational insights, MDR-RA moves into clinical validation to test iCare-RA in real-world care.
We’ll run a pilot randomised controlled trial with 100s of RA patients, comparing standard care toiCare-RA-supported treatment.
Objective:
- Validate iCare-RA: Assess how well the tool supports personalised treatment decisions and improves outcomes in MDR-RA compared to usual care.
This phase is key to proving iCare-RA’s real-world value in transforming RA management.
iCare-RA:Smarter Decisions, Better Outcomes
iCare-RA is an AI-powered tool that combines clinical, imaging, and molecular data to help clinicians:
- Predict treatment failure early
- Personalise therapy for each patient
- Minimise ineffective treatments and drug overuse
Validated in real-world care, iCare-RA aims to transform decision-making for complex RA cases.
Impactful Outputs
DrivingLasting Impact in RA Care
MDR-RA goes beyond patient-level care to support system-wide change in managing multi-drug resistant RA.
KeyGoals:
- Economic Modeling: Assess cost savings, treatment efficiency, and long-term outcomes with iCare-RA.
- Implementation Framework:Develop a roadmap for clinical adoption, with training and stakeholder strategies.
- Open Biomedical Resource: Share a rich dataset of clinical, imaging, and molecular profiles to drive future research and innovation.
These efforts ensure MDR-RA delivers sustainable tools, scalable solutions, and lasting value for health systems and RA care across Europe
The Impact
MDR-RA is transforming care—offering real hope to patients, families, and healthcare systems across Europe.
MDR-RA targets a major challenge in rheumatoid arthritis: multi-drug resistance. By uncovering why treatments fail and closing clinical gaps, it aims to transform care and reduce disease burden.
Key Impacts:
- Scientific breakthrough: Advances understanding of treatment-resistant RA and boosts translational research.
- Improved care: Supports accurate diagnosis and tailored therapies for better outcomes.
- Economic impact: Optimizes treatment use—potentially saving €10 billion and 2,000 DALYs annually in Europe.
- Stronger networks: Forges lasting ties across research, industry, and patient communities.
- Sustainable tools: Provides valuable data and resources for future innovation.
MDR-RA paves the way for truly personalised RA treatment—with lasting benefits for patients and health systems.
Why MDR-RA Matters
RA affects over 7 million people in the EU and is a top cause of disability, with one in three unable to work within five years—costing Europe €55 billion annually.
Around 20% of patients have multi-drug resistant (MDR) RA, facing double the costs and a 30% drop in quality of life.
MDR-RA tackles this urgent issue by identifying what drives treatment resistance and developing iCare-RA—a personalised care algorithm to match patients with effective therapies and prevent long-term damage.
The project also supports smarter use of expensive drugs, informs new treatments ,and guides sustainable health policy—backed by early economic modelling.
Impact on Patients and Society
MDR-RA brings real, lasting benefits by advancing precision medicine in rheumatoid arthritis. It aims to improve treatment response, avoid harmful drug exposure, and prevent long-term disability from delayed disease control.
For patients, this means quicker access to effective therapies, fewer trial-and-error cycles, and better protection of mobility and quality of life.For society, it means reducing wasteful healthcare costs and improving the efficiency of national health systems.
The project also drives innovation by identifying new drug targets and diagnostics.With patient voices from the EULAR-PARE Network guiding the work, MDR-RA ensures that care remains truly patient-centered.
