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 and observational studies. 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 adalimumab (ADA) and alternative treatments such as ABA, TCZ and RTX.
Methods Charts of all RA patients taking ETN, ADA, ABA, TCZ and RTX at the Centre de Rhumatologie de l'Est du Québec were reviewed and detailed data including 28-joint disease activity score (DAS28-ESR), start and end date and motive for discontinuation were recorded. Survival estimation was explored using Kaplan-Meier analysis and the log rank test was used to check for differences between the Kaplan-Meier curves using the statistical software R.
Results A total of 474 RA patients starting treatment with ETN, ADA, ABA, TCZ or RTX were enrolled in this study. 158 patients were on ETN, 128 patients were on ADA, 73 patients were on ABA, 54 patients were on TCZ and 61 patients were on RTX therapies. Overall, DAS28-ESR decreased from 4.37 at baseline to 2.80 at month 24 for ETN, from 4.37 to 2.98 for ADA, from 4.58 to 4.06 for ABA, from 5.31 to 3.24 for TCZ and from 4.65 to 2.97 for RTX. After 24 months, using Kaplan-Meier curves plotted for all treatments, 56% of patients are still on ETN, 39% of patients are still on ADA, 38% of patients are still on ABA, 55% of patients are still on TCZ and 67% of patients are still on RTX. However, for biologic-naïve patients, 57% of patients are still on ETN, 48% of patients are still on ADA, 63% of patients are still on ABA, 73% of patients are still on TCZ and 100% of patients are still on RTX (n=2) at month 24. Statistical tests of comparison between treatment revealed significant differences (log-rank: p=0.000125).
Conclusions The present study suggests that the survival rate 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, ADA, ABA and TCZ in second line treatment. Also, ADA, ABA and TCZ has better profile when used as a first-line agent.
Girolomoni et al., 2012, Karlsson et al., 2008, Hublein et al., 2012, Strand et al., 2013
Disclosure of Interest None declared