Background Anti-cyclic citrullinated peptide (CCP) status was reported previously as predictive of abatacept response.¹ Predictors of retention with abatacept have not been published previously.

Objectives To identify predictors of abatacept retention after failing ≥1 biologic agent.

Methods ACTION is an ongoing, 2-year, international, non-interventional, prospective cohort including patients with RA treated with IV abatacept.^2,3 Patients from Canada, Germany, Greece and Italy, where patient numbers were sufficient to explore between-country effects, were included. At data cut-off (February 2012), all patients had 1-year follow up (interim analysis). Abatacept discontinuations were reported by the investigator at any time point during follow up. Socio-demographics, disease characteristics and medical history at abatacept initiation, and previous and concomitant treatments were deemed potential predictive variables. Clinically relevant variables and those with p≤0.2 (univariate analysis) were entered into a multivariate Cox proportional-hazards regression model, adjusted for clustered data from one investigator. Using backwards selection, variables with p≤0.1 were retained in the final model.

Results Overall, 865/999 (86.6%) patients who had failed ≥1 biologic agent (98% failed anti-TNF) were included. In the multivariate model, patients (n=834) had a significantly lower risk of abatacept discontinuation if they were anti-CCP positive (p<0.001; hazard ratio [HR]=0.55 [95% CI: 0.40, 0.75]), failed <2 anti-TNF agents (p=0.005 vs ≥2 anti-TNFs; 0.71 [0.56, 0.90]) and had a cardiac comorbidity at abatacept initiation (p=0.009; 0.48 [0.28, 0.83]). Patients in Greece and Italy were less likely to discontinue than patients in Germany (p<0.001 vs Germany; Greece 0.30 [0.16, 0.58]; Italy 0.50 [0.33, 0.76]; Canada 1.04 [0.78, 1.40]). There were no interactions or effects of C-reactive protein level, rheumatoid factor status, type of previous anti-TNF failure, infection at initiation and abatacept monotherapy. Sensitivity analysis, including all variables significant in univariate analysis, was consistent.

Conclusions In this first report of real-world predictors of abatacept patient retention, anti-CCP positivity and failing <2 prior anti-TNF agents were associated with higher retention. Differences in retention between some countries may reflect specificities in healthcare systems and populations. Abatacept, a biologic agent with no contraindications or special warnings for cardiac comorbidity, seems to be a good option for these patients.

References

1. Gottenberg JE, et al. Ann Rheum Dis 2012;71:1815-9;

2. Nüßlein H, et al. Ann Rheum Dis 2011;70(Suppl.3):464;

3. Nüßlein H, et al. Arthr Rheum 2012;64(Suppl10):S199

Disclosure of Interest H. Nüßlein Consultant for: Bristol-Myers Squibb, Abbott, Chugai, UCB, Essex, Wyeth, Pfizer, MSD, Novartis, Roche, Speakers bureau: Bristol-Myers Squibb, Abbott, Chugai, UCB, Essex, Wyeth, Pfizer, MSD, Novartis, Roche, R. Alten Grant/research support from: Bristol-Myers Squibb, Merck Pharma GmbH, Wyeth Pharmaceuticals, Pfizer, Consultant for: Abbott Laboratories, Horizon Pharma, Merck Pharma GmbH, Nitec Pharma GmbH, Novartis Pharmaceuticals Corporation, Roche, Speakers bureau: Abbott Laboratories, Bristol-Myers Squibb, Horizon Pharma, Merck Pharma GmbH, Novartis Pharmaceuticals Corporation, Roche, M. Galeazzi: None Declared, H. Lorenz Speakers bureau: Bristol-Myers Squibb, D. Boumpas Grant/research support from: Unconditional educational grant support, M. Nurmohamed Grant/research support from: The Jan van Breemen Research Institute has received research grants from Bristol-Myers Squibb, MSD, Roche, Abbott, Pfizer, UCB, Consultant for: Bristol-Myers Squibb, MSD, Roche, Abbott, Pfizer, UCB, Employee of: Jan van Breemen Research Institute, VU University Medical Center, Speakers bureau: Bristol-Myers Squibb, MSD, Roche, Abbott, Pfizer, UCB, W. Bensen Grant/research support from: Abbott, Amgen, Bristol-Myers Squibb, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, sanofi aventis, Schering, Takeda, UCB, Warner Chilcott, Wyet, Consultant for: Abbott, Amgen, Bristol-Myers Squibb, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, sanofi aventis, Schering, Takeda, UCB, Warner Chilcott, Wyet, Speakers bureau: Abbott, Amgen, Bristol-Myers Squibb, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, sanofi aventis, Schering, Takeda, UCB, Warner Chilcott, Wyet, G. Burmester Grant/research support from: Bristol-Myers Squibb, Abbott, Pfizer, Medimmune, Novartis, Roche, UCB, Lilly, Consultant for: Bristol-Myers Squibb, Abbott, Pfizer, MSD, Medimmune, Roche, UCB, Speakers bureau: Bristol-Myers Squibb, Abbott, Pfizer, MSD, Roche, UCB, H.-H. Peter Speakers bureau: Pfizer Germany, F. Rainer: None Declared, K. Pavelka Consultant for: Roche, Abbott, MSD, Amgen, Speakers bureau: Pfizer, MSD, UCB, Bristol-Myers Squibb, M. Chartier Consultant for: Bristol-Myers Squibb, C. Poncet Consultant for: Bristol-Myers Squibb, C. Rauch Employee of: Bristol-Myers Squibb, M. Le Bars Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb