Background In recent years, it has been reported that baseline anti-cyclic citrullinated peptide (CCP) antibody positivity is associated with a better response and retention rate in patients with rheumatoid arthritis (RA) [1,2]. However, there have been few reports describing the association of prognostic factors with the long-term clinical results represented by drug retention rate.
Objectives The aim of this study was to identify prognostic factors for abatacept (ABT) retention in clinical routine practice using data from a Japanese multicenter registry system for RA patients treated with biological DMARDs.
Methods All eligible RA patients who underwent ABT therapy from October 2010 through to March 2015 (n=513) were prospectively registered in the Tsurumai Biologics Communication Registry (TBCR). Potential prognostic factors such as baseline demographics and disease characteristics were analyzed using Log-rank test. Variables with a p value of <0.20 were included in the multivariable analysis using a Cox proportional hazard model.
Results The overall retention rate was 58.2% (95% CI; 0.49 - 0.66) at 4 years. Based on Log-rank test, previous biologics treatment (naïve vs. switch), Steinbrocker stage (1–2 vs. 3–4), RF status (negative vs. positive), anti CCP antibody status (negative vs positive) and concomitant MTX use (user vs. non-user) were eligible to enter the multivariate model (Table 1). Multivariable analysis revealed that patients had a significantly lower risk of ABT discontinuation if they were biologic-naïve (HR; 0.57, 95%CI; 0.35 - 0.91) and anti-CCP antibody positive (HR; 0.57, 95%CI; 0.32 - 0.99) (Table2). Furthermore, we divided anti-CCP antibody status into three categories (<4.5; negative, 4.5 - <100; low titer, ≥100; high titer) and examined the relationship between titer and retention rate. Kaplan-Meier curve indicated that the retention rate in high titer group was lower than that in low titer group (Figure 1).
Conclusions This study demonstrated that baseline anti-CCP antibody positivity is associated with a better long-term retention of ABT therapy. But additional therapeutic intervention would be necessary for patients with high titer to improve the short- and long-term clinical results of ABT.
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Disclosure of Interest M. Hanabayashi: None declared, N. Takahashi: None declared, Y. Yokota: None declared, H. Miyake: None declared, T. Kojima Speakers bureau: Astellas Pharma Inc., Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, abbvie, Bristol-Myers Squibb, Pfizer, Janssen Pharmaceutical K.K. and UCB Japan Co. Ltd., N. Ishiguro Speakers bureau: Astellas Pharma Inc., Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, abbvie, Bristol-Myers Squibb, Pfizer, Janssen Pharmaceutical K.K. and UCB Japan Co. Ltd.