Background The use of biologics significantly improved results of the therapy of RA pts who did not achieve the target disease activity level on traditional DMARDS treatment. However the biologic therapy is in many cases withdrawn due to inefficacy or side effects (seldom because of sustained remission). Retention on treatment is a good integral index of efficacy and safety of biologics used in the real clinical practice.
Objectives To assess the treatment survival of various biologics in RA pts in the real clinical practice.
Methods Patients from MAR with RA receiving biologics were enrolled. Cases with missed results were excluded. A Cox proportional hazards regression model was used to determinethe predictors of the treatment discontinuation risk. Comparison of biologics retention rates for different biologicswas performed by means of Kaplan-Meier survival curves. Bonferroniadjustment was applied because of multiplicity of comparisons.
Results 306 RA pts (mean age 54,5 years, mean age of disease onset 39,6 years, 86,5% women, 18% smokers, RF-positive 83,7%) were included in the study and 394 treatment courses (263 retrospective and 131 prospective) were analyzed. It was shown that significant independent predictors of discontinuation risk were: the biologic drug, the sequence number of the biologic drug in the patient and the age of RA onset. Risk of withdrawal was minimal by the use of the first biologic and increased by administration of the next ones. It also increased in pts with late onset of RA. Mass body index, age of the patient and the dose of methotrexate did not show significant correlations. Abatacept (ABA) demonstrated significant superiority over adalimumab (ADA) (p<0.001), infliximab (INF) (p<0.001), rituximab (RTM) (p=0.004) and etanercept (ETA) (p=0.035) when they was used as the first biologic drug. The treatment survival of tocilizumab was significantly higher compared to INF (p=0.02). As a second-line biological therapy ADA was maintained significantly longer than the INF (p=0.048).
Conclusions Results of the real clinical practice trial show the significant differences in the retention rates of some biologics. It is reasonable to take these differences into consideration by the planning of the biologic treatment of RA pts.
Disclosure of Interest None declared