Background Some studies have suggested that efficacy of triple non-biologic disease modifying anti-rheumatic drug (nbDMARD) therapy for Rheumatoid Arthritis (RA) is similar to biologic combination therapy (1).
Objectives To examine the difference in need to advance therapy after treatment with triple nbDMARD (Group 1) or TNF inhibitors in combination with methotrexate (MTX)) (Group 2).
Methods RA patients enrolled in Corrona between 10/2001 – 8/2015 initiating either triple nbDMARD therapy or a biologic agent in combination with MTX and with at least 1 follow-up visit were included. Group 1 included patients who started either concurrently or sequentially MTX, hydroxychloroquine and sulfasalazine. TNF inhibitors could be started concurrently with or added to MTX in Group 2. Advancement of therapy was compared for the two groups after propensity score (PS) matching and defined as discontinuing one or more of triple nbDMARD and adding a biologic/adding another nbDMARD for Group 1 and adding a second nbDMARD/switching to a different biologic for Group 2. Index visit was defined as initiation of triple therapy for Group 1 and date of biologic initiation for Group 2. Kaplan-Meier estimates were used to determine time to advancement of therapy.
Results There were 236 and 2,938 in Gp 1 and 2 respectively. After PS matching, N=221 were included in each group. Groups were well balanced with a mean age of 58.5 yrs vs 58.6 yrs, mean disease duration of 10.5 yrs vs 10.6 yrs and mean clinical disease activity index (CDAI) of 15.9 vs 16.1 for groups 1 and 2 resp. About 76% (95% CI: 69.5%, 81.3%) of the Gp 1 patients continued on initial therapy compared to 82% (95% CI: 76.4%, 86.8%) in Gp 2 at 12 months of follow-up. Median time to therapy advancement was 49 months (95% CI: 35, 59) for group 1 and 69 months (95% CI: 46, 100) for group 2. About 40% of patients in triple nbDMARD group had to advance therapy during 12 months of follow-up, vs 39% in group 2. Types of first advancement of therapy is shown in table 1.
Conclusions Therapy with a biologic agent resulted in a numerically but not statistically significant prolonged time to advancement therapy compared to triple nbDMARD therapy. Future examination of the need to advance therapy with a larger sample size may provide further insights for treatment practices.
Van Vollenhoven RF et al. Lancet. 2012 May 5; 379 (9827):1712–20. doi: 10.1016/S0140-6736(12)60027-0
Acknowledgement This study is sponsored by Corrona, LLC. The Corrona, LLC. RA registry has been supported through contracted subscriptions in the last two years by AbbVie, Amgen, BMS, Crescendo, Genentech, Horizon Pharma USA, Janssen, Eli Lilly, Novartis, Pfizer, and UCB. The design, study conduct, and financial support for the study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.
Disclosure of Interest D. Pappas Employee of: Corrona, LLC, Paid instructor for: Novartis, C. Karki Employee of: Corrona, LLC, H. Litman Employee of: Corrona, LLC, J. Greenberg Shareholder of: Corrona, LLC, Consultant for: AstraZeneca, Celgene, Genentech, Janssen, Novartis and Pfizer, Employee of: Corrona, LLC, J. Kremer Shareholder of: Corrona, LLC, Consultant for: AbbVie, Amgen, BMS, Genentech, GSK, Lilly, Medimmune, Pfizer, Sanofi, Employee of: Corrona, LLC, Speakers bureau: Genentech (for non-branded talk only), V. Garg Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc.