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Abstract
Background There are limited data to guide the selection of the first non-anti-TNF biologic DMARD (bDMARDs) after anti-TNF failure in rheumatoid arthritis (RA) patients.
Objectives To evaluate the drug survival of non-anti-TNF IV bDMARDs in RA patients with inadequate response to ≥1 TNF inhibitors (TNF-IR) in daily clinical practice.
Methods All TNF-IR patients treated with different non-anti-TNF bDMARDS in our center between 01/01/2007 to 31/12/2014 were included in the study. Analyses were stratified by the first biologic agent used after TNF failure (Tocilizumab-TCZ, Rituximab-RTX, Abatacept-ABA) and then by RF status and conventional synthetic DMARD (csDMARD) administration. Kaplan-Meier survival analysis and log-rank test of equality pairwise over strata were performed.
Results 94 TNF-IR consecutive RA patients treated with TCZ (n=24), RTX (n=49) or ABA (n=21) were included and followed for 24.2±18.8 months. 84/94 (89.4%) were women with a mean age of 64.5±15 years, rheumatoid factor (RF) positive were 49/94 (52%) patients. The baseline characteristics did not differ between the 3 groups, except from RF positivity which was more common in the RTX group compared to the TCZ group (p=0.01). The drug survival rates for TCZ, RTX and ABA were 79%, 83% and 76% at 12 months and 60%, 68%, 44% at 24 months, respectively (p=NS). Similarly, the mean time for drug discontinuation was 29.7, 41.7 and 27.1 months respectively and did not differ between groups (p=NS). Among RF+ patients, RTX (p=0.007) and TCZ (p=0.05) demonstrated better survival compared to ABA while there was no difference in drug survival among RF negative patients. There was a tendency for better drug survival among RA patients treated with RTX in combination with csDMARDs compared to combination ABA therapy (p=0.06) but this did not reach statistical significance.
Conclusions In this observational retrospective study, overall there was no significant difference in drug survival, between non-anti-TNF bDMARDs after anti-TNF failure, with the exception of RF+ patients where RTX and TCZ demonstrated better survival compared to ABA.
Acknowledgements This work was supported in part by research grants from the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece.
Disclosure of Interest None declared