Background In recent years, major advance has been made in the treatment of rheumatoid arthritis (RA). The efficacy of tumor necrosis factor-α (TNF-α) inhibitor has been demonstrated in different controlled clinical trials. However, some patients have inadequate response to TNF-α inhibitors and may switch to an alternative treatment from a different class of drugs, such as abatacept (ABA), tocilizumab (TCZ) and rituximab (RTX). ABA, TCZ and RTX are indicated for use after inadequate response to traditional disease-modifying antirheumatic drugs (DMARD) or TNF-α inhibitors for the treatment of RA.
Objectives The objective of this study was to assess in Canadian clinical practice the survival rate in patients with RA treated with a TNF-α inhibitor such as etanercept (ETN) and alternative treatments such as ABA, TCZ and RTX.
Methods Charts of all RA patients taking ETN, ABA, TCZ and RTX at the Centre de Rhumatologie de l’Est du Québec were reviewed and detailed data including demographic information, disease characteristics, rheumatoid factor and anti-cyclic citrullinated peptide status, co-morbid medical condition, 28-joint disease activity score (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Health Assessment Questionnaire-Disease Index (HAQ-DI) were collected. Descriptive statistics were used to describe patients initiating biologic treatment in this real-world setting.
Results A total of 325 RA patients starting treatment with ETN, ABA, TCZ or RTX were enrolled in this study. 158 patients were on ETN, 64 patients were on ABA, 53 patients were on TCZ and 50 patients were on RTX therapies. Overall, DAS28-ESR decreased from 4.37 at baseline to 2.80 at month 24 for ETN, from 4.57 to 4.17 for ABA, from 5.31 to 2.24 for TCZ and from 4.67 to 2.88 for RTX. After 24 months, for all patients, 59% of patients are still on ETN, 59% of patients are still on ABA, 62% of patients are still on TCZ and 78% of patients are still on RTX. However, for biologic-naïve patients, 66% of patients are still on ETN (n=123), 67% of patients are still on ABA (n=15), 86% of patients are still on TCZ (n=7) and 100% of patients are still on RTX (n=3) at month 24.
Conclusions The present study suggests that the survival rate of treatment for biologic-naïve patients is higher than on patients who failed to respond to their previous biologic. It also suggests that RTX has a better survival rate than ETN, ABA and TCZ in second line treatment. Also, ABA and TCZ has better profile when used as a first-line agent.
References Girolomoni et al., 2012. Safety of anti-TNFα agents in the treatment of psoriasis and psoriatic arthritis. Immunopharmacology and Immunotoxicology 34(4):548-560.
Karlsson et al., 2008. Treatment response to a second or third TNF-inhibitor in RA: results from the South Swedish Arthritis Treatment Group Register. Rheumatology 47:507-513.
Hublein et al., 2012. Real-world efficacy and safety of Abatacept treatment for RA: 12-month interim analysis of the Action study. Arthritis & Rheumatism 64(10):S199-S199.
Disclosure of Interest None Declared