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The comparative effectiveness of abatacept versus anti-tumour necrosis factor switching for rheumatoid arthritis patients previously treated with an anti-tumour necrosis factor
  1. Leslie R Harrold1,
  2. George W Reed1,
  3. Joel M Kremer2,
  4. Jeffrey R Curtis3,
  5. Daniel H Solomon4,
  6. Marc C Hochberg5,
  7. Jeffrey D Greenberg6
  1. 1University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Albany Medical College, Albany, New York, USA
  3. 3Department of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  6. 6Department of Rheumatology, New York University Hospital for Joint Diseases, New York, USA
  1. Correspondence to Dr Leslie R Harrold, Department of Orthopedics, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA; Leslie.Harrold{at}


Objective We compared the effectiveness of abatacept (ABA) versus a subsequent anti-tumour necrosis factor inhibitor (anti-TNF) in rheumatoid arthritis (RA) patients with prior anti-TNF use.

Methods We identified RA patients from a large observational US cohort (2/1/2000–8/7/2011) who had discontinued at least one anti-TNF and initiated either ABA or a subsequent anti-TNF. Using propensity score (PS) matching (n:1 match), effectiveness was measured at 6 and 12 months after initiation based on mean change in Clinical Disease Activity Index (CDAI), modified American College of Rheumatology (mACR) 20, 50 and 70 responses, modified Health Assessment Questionnaire (mHAQ) and CDAI remission in adjusted regression models.

Results The PS-matched groups included 431 ABA and 746 anti-TNF users at 6 months and 311 ABA and 493 anti-TNF users at 12 months. In adjusted analyses comparing response following treatment with ABA and anti-TNF, the difference in weighted mean change in CDAI (range 6–8) at 6 months (0.46, 95% CI −0.82 to 1.73) and 12 months was similar (−1.64, 95% CI −3.47 to 0.19). The mACR20 responses were similar at 6 (28–32%, p=0.73) and 12 months (35–37%, p=0.48) as were the mACR50 and mACR70 (12 months: 20–22%, p=0.25 and 10–12%, p=0.49, respectively). Meaningful change in mHAQ was similar at 6 and 12 months (30–33%, p=0.41 and 29–30%, p=0.39, respectively) as was CDAI remission rates (9–10%, p=0.42 and 12–13%, p=0.91, respectively).

Conclusions RA patients with prior anti-TNF exposures had similar outcomes if they switched to a new anti-TNF as compared with initiation of ABA.

  • Rheumatoid Arthritis
  • Anti-TNF
  • DMARDs (biologic)

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