Background Sustainability of treatment is important to consider when selecting a therapy for chronic conditions such as RA. Sustainability is a useful clinical marker for both long-term efficacy and safety. A recently published randomized controlled trial has demonstrated similar efficacy and safety profiles between abatacept (ABA) and adalimumab over 2 years.1,2
Objectives To assess the long-term sustainability of ABA and anti-TNFs following treatment failure with a conventional synthetic DMARD (csDMARD) in comparable cohorts of patients (pts) with RA.
Methods Data from pts with RA seen at two tertiary centres and prescribed either ABA or a TNF inhibitor (adalimumab, certolizumab, etanercept, golimumab or infliximab) as their first biologic (b)DMARD after 1 January 2006 were extracted from the RHUMADATA® registry. The choice of therapy was a joint decision between the pt and the treating physician. Pts were followed until either they discontinued treatment, were lost to follow-up or the cut-off date of 9 January 2017. Pt baseline characteristics were compared using descriptive statistics and the cumulative incidence of biologic agent discontinuation using Kaplan-Meier methods. Overall differences in the discontinuation rates of biologic agents were tested using the log-rank test.
Results Overall, 641 pts met study criteria; 82 pts received ABA and 559 TNF inhibitors (adalimumab=136, certolizumab=52, etanercept=226, golimumab=88 and infliximab=57) as first-line treatment following inadequate response to csDMARDs. No clinically significant differences in baseline characteristics were noted between treatment groups. Most pts were diagnosed after January 2000 (72.5%) and were women (77.5%). Average age at diagnosis was 47.1 (SD=13.4) years, with a mean disease duration of 7.2 (7.8) years, and a mean CDAI of 43.1 (32.5) at baseline. No significant differences in retention rates were observed in the ABA and anti-TNF groups (Table, Figure). On average, pts treated with anti-TNFs and ABA maintained their treatment for 1.59 (1.91) and 1.90 (2.08) years, respectively. Lack of efficacy (47.6%) and adverse effects (22.0%) were the most commonly cited reasons for treatment discontinuation.
Conclusions Abatacept and TNF inhibitors demonstrate similar sustainability at 8-year, supporting studies1,2 that demonstrate that abatacept used after csDMARDs inadequate response is as safe and effective as a TNF targeting agents in the long term.
Schiff M, et al. Ann Rheum Dis 2014;73:86–94.
Schiff M, et al. Ann Rheum Dis 2008;67:1096–1103.
Disclosure of Interest D. Choquette Consultant for: BMS, Speakers bureau: BMS, 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, E. Alemao Shareholder of: BMS, Employee of: BMS, 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, M. Mtibaa Shareholder of: BMS, Employee of: BMS, E. Muratti Employee of: BMS, J.-P. Pelletier: None declared, R. Postema Shareholder of: BMS, Employee of: BMS, 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
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.