Background The order of use of biologic agents is still a question for debate. Phase III trial data in MTX-IR patients show comparable efficacy results across biologic agents and limited head-to-head studies have been published. Registries offer a unique opportunity to prospectively monitor the effectiveness of these agents in a clinical setting.
Objectives To evaluate if patients with rheumatoid arthritis (RA) treated with abatacept after failure to either a first line agent (MTX-IR) or a second line anti-TNF agents (TNF-IR) have a different drug survival rate than patients similarly treated with adalimumab, etanercept or infliximab.
Methods RA patients prescribed a first biologic agent after January 1st 2007 were included in the present analysis. Two cohorts were extracted, the first included all patients prescribed their first biologic agent, abatacept (ABA), adalimumab (ADA), etanercept (ETA) or infliximab (INF); the second included all patients failing their first biologic agent and switching to a second one. Baseline demographics for both cohorts included age, disease duration, HAQ-DI, fatigue and pain visual analog scale evaluation (VAS), TJC, SJC, DAS 28 ESR and SDAI. Statistical analysis was performed using SAS version 9.3. RHUMADATA® is a clinical database and registry used daily in clinical practice at the IRM and the CORQ.
Results A total of 526 patients were analysed, 340 were included in the first cohort and 186 composed the second cohort. No clinically significant differences in baseline characteristics were noted between treatment groups. The 5 year retention rate of ABA, ADA, ETA and INF post MTX failure were 64%, 40%, 49% and 42% without significant statistical differences (Log-Rank p=0.29). Similarly, the 5 year retention rates for patients having failed a first anti-TNF agent are not statistically different (44% (ABA), 36% (ADA), 41% (ETA) and 16% (INF) (Log-Rank p=0.07)) except when comparing ABA to INF (Bonferroni adjusted log-rank p-value=0.04).
Conclusions Abatacept, adalimumab, etanercept and infliximab after MTX failure have similar 5-years retention rates. Prescribing abatacept after failing a first anti-TNF agent offers a similar effectiveness as ETA and ADA, but a significantly better retention rate than INF.
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Acknowledgements The Rhumadata clinical database and registry is supported by unrestricted grant from Abbvie Canada, Amgen Canada, BMS Canada, Pfizer Canada, Roche Canada
Disclosure of Interest : None declared