Background EULAR recommends initiation of biologic agents in combination with MTX in pts with RA after failure of conventional synthetic (cs)DMARDs and in the presence of poor prognostic factors. In addition, low-dose glucocorticoids should be considered as part of the treatment strategy, but should be tapered as rapidly as is clinically feasible.1
Objectives To assess changes over 2 yrs in concomitant treatment strategy with csDMARDs and, more specifically, glucocorticoids in pts with RA who initiated IV abatacept (ABA) and had previously failed ≥1 biologic agent in the real-world ACTION study.
Methods ACTION is a 2-year, international (Austria, Belgium, Canada, Czech Republic, Denmark, Germany, Greece, Italy, the Netherlands), non-interventional cohort of pts with RA who initiated IV ABA between May 2008 and January 2011. At each clinical visit, changes in concomitant treatments were collected, including changes in dosage. The use of concomitant treatments is reported at ABA initiation and at 24 mths for pts who remained on ABA at 24 mths.
Results Among 1131 evaluable pts, 1009 failed ≥1 biologic agent. Of these pts, ABA was initiated as monotherapy in 237/1009 (23.5%) pts and in combination with a csDMARD in 772/1009 (76.5%) pts. At baseline, glucocorticoids were used by 734/1009 (72.7%) pts (median dose: 7.5 mg; n=692). Concomitant DMARD and glucocorticoid use was assessed in 407/1009 (40.3%) pts who were on abatacept at 24 mths and had available data. Of these pts, ABA was initiated as monotherapy in 88/407 (21.6%) pts and in combination with csDMARDs in 319/407 (78.4%) pts. There was no change in treatment strategy at 24 mths in 348/407 (85.5%) pts. Over 24 mths, csDMARDs were initiated in 21/407 (5.2%) pts and were stopped in 38/407 (9.3%) pts; mean MTX dose remained stable (approximately 14 mg/wk). The proportion of pts who received glucocorticoids and the corresponding median dose decreased from 301/407 (74.0%) pts (median dose: 6.5 mg; dose available in 284 pts) at baseline to 237/407 (58.2%) pts (median dose: 5 mg; dose available in 232 pts) at 24 mths. Over 24 mths, glucocorticoids were initiated in 16/407 (3.9%) pts (median dose: 5 mg) and were stopped in 80/407 (19.7%) pts; glucocorticoid dose decreased in 88/216 (40.7%) pts and increased in 19/216 (8.8%) pts when doses were available.
Conclusions The majority of pts who initiated IV abatacept remained on the same csDMARD treatment strategy (monotherapy or combination) at 24 mths. The proportion of pts who received glucocorticoids and the corresponding glucocorticoid dose decreased over 24 mths, in line with the 2013 update of the EULAR recommendation that glucocorticoids should be tapered as rapidly as is clinically feasible to reduce the risk of side effects.1
Smolen JS, et al. Ann Rheum Dis 2013 Oct 25, doi: 10.1136/annrheumdis-2013-204573.
Disclosure of Interest R. Alten Grant/research support: BMS, Speakers bureau: BMS, H. Nüβlein Consultant for: Bristol-Myers Squibb, Abbott, Chugai, UCB, Essex, Wyeth, Pfizer, MSD, Novartis and Roche, Speakers bureau: Bristol-Myers Squibb, Abbott, Chugai, UCB, Essex, Wyeth, Pfizer, MSD, Novartis and Roche, M. Galeazzi: None declared, H.-M. Lorenz Consultant for: BMS, Speakers bureau: BMS, M. Nurmohamed Grant/research support: The Jan van Breemen Research Institute has received research grants from Roche, Abbott, Pfizer, UCB and BMS, Consultant for: Roche, Schering-Plough, BMS, UCB, Wyeth, Pfizer and MSD, Speakers bureau: Abbott, Roche, Pfizer and BMS, W. Bensen Grant/research support: Abbott, Amgen, BMS, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, Sanofi-Aventis, Schering, Takeda, UCB, Warner Chilcott, Wyeth, Consultant for: Abbott, Amgen, BMS, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, Sanofi-Aventis, Schering, Takeda, UCB, Warner Chilcott, Wyeth, Speakers bureau: Abbott, Amgen, BMS, Janssen, Merck, Lilly, Novartis, Pfizer, Proctor and Gamble, Roche, Sanofi-Aventis, Schering, Takeda, UCB, Warner Chilcott, Wyeth, G.-R. Burmester Grant/research support: Clinical trials for BMS, AbbVie, Pfizer, Medimmune, Novartis, Roche, UCB, Lilly, Consultant for: BMS, AbbVie, Pfizer, MSD, Medimmune, Roche, UCB, Speakers bureau: BMS, Abbott, Pfizer, MSD, Roche, UCB, H.-H. Peter: None declared, K. Pavelka Grant/research support: MSD, Pfizer, Amgen, AbbVie, Roche, Consultant for: MSD, Pfizer, Amgen, AbbVie, Roche, M. Chartier Consultant for: BMS, C. Poncet Consultant for: BMS, C. Rauch Employee of: BMS, M. Le Bars Shareholder of: BMS, Employee of: BMS
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