Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 19;8(1):71-78.
doi: 10.36469/jheor.2021.23684.

Persistence with Early-Line Abatacept versus Tumor Necrosis Factor-Inhibitors for Rheumatoid Arthritis Complicated by Poor Prognostic Factors

Xue Han  1 , Francis Lobo  1 , Michael S Broder  2 , Eunice Chang  2 , Sarah N Gibbs  2 , David J Ridley  3 , Irina Yermilov  2
Affiliations

Persistence with Early-Line Abatacept versus Tumor Necrosis Factor-Inhibitors for Rheumatoid Arthritis Complicated by Poor Prognostic Factors

Xue Han et al. J Health Econ Outcomes Res. .

Abstract

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling and destruction that leads to severe disability. There are no clear guidelines regarding the order of therapies. Gathering data on treatment patterns outside of a clinical trial setting can provide useful context for clinicians. Objectives: To assess real-world treatment persistence in early-line abatacept versus tumor necrosis factor-inhibitors (TNFi) treated patients with RA complicated by poor prognostic factors (including anti-cyclic citrullinated peptide antibodies [ACPA] and rheumatoid factor [RF] seropositivity). Methods: We performed a multi-center retrospective medical record review. Adult patients with RA complicated by poor prognostic factors were treated with either abatacept or TNFis as the first biologic treatment at the clinic. Poor prognostic factors included ACPA+, RF+, increased C-reactive protein levels, elevated erythrocyte sedimentation rate levels, or presence of joint erosions. We report 12-month treatment persistence, time to discontinuation, reasons for discontinuation, and risk of discontinuation between patients on abatacept versus TNFi. Select results among the subgroup of ACPA+ and/or RF+ patients are presented. Results: Data on 265 patients (100 abatacept, 165 TNFis) were collected. At 12 months, 83% of abatacept patients were persistent versus 66.1% of TNFi patients (P=0.003). Median time to discontinuation was 1423 days for abatacept versus 690 days for TNFis (P=0.014). In adjusted analyses, abatacept patients had a lower risk of discontinuing index treatment due to disease progression (0.3 [95% confidence interval (CI): 0.1-0.6], P=0.001). Among the subgroup of ACPA+ and/or RF+ patients (55 abatacept, 108 TNFis), unadjusted 12-month treatment persistence was greater (83.6% versus 64.8%, P=0.012) and median time to discontinuation was longer (961 days versus 581 days, P=0.048) in abatacept versus TNFi patients. Discussion: Patients with RA complicated by poor prognostic factors taking abatacept, including the subgroup of patients with ACPA and RF seropositivity, had statistically significantly higher 12-month treatment persistence and a longer time to discontinuation than patients on TNFis. Conclusions: In a real-world setting, RA patients treated with abatacept were more likely to stay on treatment longer and had a lower risk of discontinuation than patients treated with TNFis.

Keywords: abatacept; disease modifying antirheumatic drugs; rheumatoid arthritis; therapy persistence; tumor necrosis factor inhibitors.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Study Design
Abbreviations: FDA, Food and Drug Administration; IRB, Institutional Review Board; TNFi, tumor necrosis factor-inhibitors. *In a retrospective study, data usually cannot be collected after IRB approval.
Figure 2.
Figure 2.. Time to Discontinuation of Index Treatment Among All Patients (N=265)
Abbreviations: CI, confidence interval; N/A, not applicable; TNFi, tumor necrosis factor inhibitor. Blue solid line=TNFi; Red dashed line=abatacept
Figure 3.
Figure 3.. Time to Discontinuation of Index Treatment Among ACPA+ and/or RF+ Patients (n=163)
Abbreviations: ACPA+, positive anti-cyclic citrullinated peptide antibodies; CI, confidence interval; N/A, not applicable; RF+, positive rheumatoid factor antibodies; TNFi, tumor necrosis factor inhibitor. Blue solid line=TNFi; Red dashed line=abatacept
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Aletaha Daniel, Neogi Tuhina, Silman Alan J., Funovits Julia, Felson David T., Bingham Clifton O., III, Birnbaum Neal S., Burmester Gerd R., Bykerk Vivian P., Cohen Marc D., Combe Bernard, Costenbader Karen H., Dougados Maxime, Emery Paul, Ferraccioli Gianfranco, Hazes Johanna M. W., Hobbs Kathryn, Huizinga Tom W. J., Kavanaugh Arthur, Kay Jonathan, Kvien Tore K., Laing Timothy, Mease Philip, Ménard Henri A., Moreland Larry W., Naden Raymond L., Pincus Theodore, Smolen Josef S., Stanislawska-Biernat Ewa, Symmons Deborah, Tak Paul P., Upchurch Katherine S., Vencovský Jiří, Wolfe Frederick, Hawker Gillian. Aug 10;2010 Arthritis & Rheumatism. 62(9):2569–2581. doi: 10.1002/art.27584. doi: 10.1002/art.27584. - DOI - DOI - PubMed
    1. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. van der Woude Diane, van der Helm-van Mil Annette H.M. Apr;2018 Best Practice & Research Clinical Rheumatology. 32(2):174–187. doi: 10.1016/j.berh.2018.10.005. doi: 10.1016/j.berh.2018.10.005. - DOI - DOI - PubMed
    1. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Myasoedova Elena, Crowson Cynthia S., Kremers Hilal Maradit, Therneau Terry M., Gabriel Sherine E. Feb 26;2010 Arthritis & Rheumatism. 62(6):1576–1582. doi: 10.1002/art.27425. doi: 10.1002/art.27425. - DOI - DOI - PMC - PubMed
    1. Clinical identification and treatment of a rapidly progressing disease state in patients with rheumatoid arthritis. Emery P., McInnes I.B., van Vollenhoven R., Kraan M.C. 2008Rheumatology (Oxford) 47(4):392–398. doi: 10.1093/rheumatology/kem257. doi: 10.1093/rheumatology/kem257. - DOI - DOI - PubMed
    1. Progression of joint damage in early rheumatoid arthritis: association with HLA–DRB1, rheumatoid factor, and anti–citrullinated protein antibodies in relation to different treatment strategies. de Vries-Bouwstra J. K., Goekoop-Ruiterman Y. P. M., Verpoort K. N., Schreuder G. M. T., Ewals J. A. P. M., Terwiel J. P., Ronday H. K., Kerstens P. J. S. M., Toes R. E. M., de Vries R. R. P., Breedveld F. C., Dijkmans B. A. C., Huizinga T. W. J., Allaart C. F. 2008Arthritis & Rheumatism. 58(5):1293–1298. doi: 10.1002/art.23439. doi: 10.1002/art.23439. - DOI - DOI - PubMed

LinkOut - more resources