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Observational Study
. 2019 Jun 6;21(1):138.
doi: 10.1186/s13075-019-1917-8.

Persistence rates of abatacept and TNF inhibitors used as first or second biologic DMARDs in the treatment of rheumatoid arthritis: 9 years of experience from the Rhumadata® clinical database and registry

Denis Choquette  1 , Louis Bessette  2 , Evo Alemao  3 , Boulos Haraoui  4 , Roelien Postema  5 , Jean-Pierre Raynauld  4 , Louis Coupal  4
Affiliations
Observational Study

Persistence rates of abatacept and TNF inhibitors used as first or second biologic DMARDs in the treatment of rheumatoid arthritis: 9 years of experience from the Rhumadata® clinical database and registry

Denis Choquette et al. Arthritis Res Ther. .

Abstract

Background: Treatment persistence is an important consideration when selecting a therapy for chronic conditions such as rheumatoid arthritis (RA). We assessed the long-term persistence of abatacept or a tumor necrosis factor inhibitor (TNFi) following (1) inadequate response to a conventional synthetic disease-modifying antirheumatic drug (first-line biologic agent) and (2) inadequate response to a first biologic DMARD (second-line biologic agent).

Methods: Data were extracted from the Rhumadata® registry for patients with RA prescribed either abatacept or a TNFi (adalimumab, certolizumab, etanercept, golimumab, or infliximab) who met the study selection criteria. The primary outcome was persistence to abatacept and TNFi treatment, as first- or second-line biologics. Secondary outcomes included the proportion of patients discontinuing therapy, reasons for discontinuation, and predictors of discontinuation. Persistence was defined as the time from initiation to discontinuation of biologic therapy. Baseline characteristics were compared using descriptive statistics; cumulative persistence rates were estimated using Kaplan-Meier methods, compared using the log-rank test. Multivariate Cox proportional hazard models were used to compare the persistence between treatments, controlling for baseline covariates.

Results: Overall, 705 patients met the selection criteria for first-line biologic agent initiation (abatacept, n = 92; TNFi, n = 613) and 317 patients met the criteria for second-line biologic agent initiation (abatacept, n = 105; TNFi, n = 212). There were no clinically significant differences in baseline characteristics between the treatments with either first- or second-line biologics. Persistence was similar between the first-line biologic treatments (p = 0.7406) but significantly higher for abatacept compared with TNFi as a second-line biologic (p = 0.0001). Mean (SD) times on first-line biologic abatacept and TNFi use were 4.53 (0.41) and 5.35 (0.20) years, and 4.80 (0.45) and 2.82 (0.24) years, respectively, as second-line biologic agents. The proportion of patients discontinuing abatacept and TNFi in first-line was 51.1% vs. 59.5% (p = 0.1404), respectively. In second-line, it was 57.1% vs. 74.1% (p = 0.0031). The main reasons for stopping both treatments were inefficacy and adverse events.

Conclusions: Abatacept and TNFi use demonstrated similar persistence rates at 9 years as a first-line biologic agent. As a second-line biologic agent, abatacept had better persistence rates over a TNFi.

Keywords: Abatacept; Disease-modifying antirheumatic drugs (biologic); Persistence; Registry; Rheumatoid arthritis; TNF inhibitor.

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Conflict of interest statement

DC is a consultant and speaker for Amgen, AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck, Novartis, Pfizer, Roche, and Sandoz. LB is a consultant and speaker for, and has received research support from, AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, and UCB; in addition, LB has received speaker fees from Merck and research support from Merck and Sanofi. EA and RP are employees of and/or shareholders of and/or hold stock options in Bristol-Myers Squibb. BH is a consultant for AbbVie, Amgen, Lilly, Merck, Pfizer, and UCB; in addition, BH is a speaker for Pfizer and has received research support from AbbVie. J-PR is a speaker and consultant for AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB; in addition, J-PR has received consulting fees and research support from Arthrovision Inc. LC declares no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier retention curves in patients failing a csDMARDs and b a first bDMARD. bDMARD, biologic disease-modifying antirheumatic drug; csDMARD, conventional synthetic disease-modifying antirheumatic drug; TNFi, tumor necrosis factor inhibitor
Fig. 2
Fig. 2
Multivariate analysis showing the predictors of biologic failure when used in patients with an inadequate response to a first bDMARD (second-line biologic initiation cohort). CI, confidence interval; COX2, cyclooxygenase 2; DAS28-4, disease activity score in 28 joints (four variables); ESR, erythrocyte sedimentation rate
See this image and copyright information in PMC

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