Background In the absence of biomarkers predicting response to a specific therapy, the choice of second biologic is based mostly on habit and availability of an alternative agent. Traditionally, a second anti-TNF was the preferred option, but recent registry data point to better responses and retention if a drug with a different mode of action is prescribed.
Objectives Assess the long-term retention of rituximab (RTX) and TNFi following first biologic (b)DMARD inadequate response in RHUMADATA® registry patients (pts) with RA.
Methods Data from RHUMADATA® pts with RA prescribed either RTX or TNFi as the second bDMARD after 1 January 2006 were analysed. Pts were followed until treatment discontinuation or 9 January 2017 cut-off. Pt characteristics were compared using descriptive statistics, bDMARD discontinuation rates using Kaplan-Meier methods, and proportional hazard models were used to identify predictors of treatment discontinuation.
Results Data for 53 and 194 pts prescribed RTX or a TNFi, respectively, as second-line treatment were extracted. No clinically significant differences in baseline characteristics were noted between treatment groups. Most pts were women (74.9%), average age (SD) was 45.2 (12.9) years at diagnosis and disease duration 10.5 (8.7) years. Most pts were stopping an anti-TNF agent: 100% of those who were switched to RTX and 83% of those who were prescribed a second anti-TNF. Overall, 77.3% of pts stopped their first bDMARD after >6 months of treatment (secondary failure). Significant differences in retention between RTX and TNFi groups (log-rank p≤.0001) were observed (Table, Figure). Results remained unchanged for pts treated with TNFi only in first line, and primary/secondary failure of the first bDMARD did not affect sustainability of the second agent. Lack of efficacy (54.4%) and AEs (16.5%) were the most commonly cited reasons for treatment discontinuation.
Conclusions Rituximab has better sustainability over a second line TNFi in RA patients having failed one prior bDMARD.
Disclosure of Interest D. Choquette Grant/research support from: Roche, Consultant for: Roche, L. Bessette Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant for: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, B. Haraoui Grant/research support from: BMS, Janssen, Roche, Consultant for: Abbvie, Amgen, BMS, Celgene, Janssen, Merck, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Pfizer, UCB, F. Massicotte: None declared, J.-P. Pelletier: None declared, J.-P. Raynauld Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Sanofi, Novartis, UCB, M.-A. Rémillard: None declared, D. Sauvageau: None declared, A. Turcotte Consultant for: Amgen, Abbvie, BMS, Celegene, Janssen, Roche, Pfizer, Lilly, Novartis, Merck, Sanofi, UCB, Speakers bureau: Amgen, Abbvie, BMS, Celegene, Janssen, Roche, Pfizer, Lilly, Novartis, Merck, Έ. Villeneuve Consultant for: Celgene, Cimzia, Pfizer, Speakers bureau: Abbvie, Roche, BMS, L. Coupal: None declared