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Response: As discussed in detail in the CY 2025 PFS proposed rule (89 FR 62088 through 62092), our proposed performance threshold policy is based on current statutory requirements

Refractory RA is when an individual with RA fails to respond to DMARDs treatment (196)

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It also decreased the expression of the PI3K/AKT/mTOR pathway and the NF-/TGF- pathway, inhibited CK18 and COX2 activity, increased the concentration of BAX and P53 proteins, and decreased Bcl-2, IL-6, IL-1, MMP2, and MMP9

The deposition of a considerable amount of antibodies, along with complement activation and immune cell activation, might result in acute liver failure due to antibody-mediated inflammation [90]