Comparative effectiveness of abatacept versus tocilizumab in rheumatoid arthritis patients with prior TNFi exposure in the US Corrona registry

Abstract

BackgroundWe compared the effectiveness of abatacept (ABA) vs tocilizumab (TCA) in tumor necrosis factor inhibitor (TNFi) experienced patients.MethodsWe identified rheumatoid arthritis (RA) patients from a large observational US cohort (1 January 2010–31 May 2014) who had discontinued at least one TNFi and initiated ABA or TCZ in moderate or high disease activity based on the Clinical Disease Activity Index (CDAI) and had no prior exposure to the comparator drug. Using propensity score matching (1:1) stratified by prior TNF use (1 TNFi vs ≥2 TNFis), effectiveness at 6 months after initiation was evaluated. Mean change in CDAI over 6 months following initiation was the primary outcome, with secondary outcomes of achievement of low disease activity/remission (CDAI ≤ 10) and mean change in modified Health Assessment Questionnaire (mHAQ) score.ResultsThe 264 pairs of propensity score-matched ABA and TCZ initiators were well matched with no substantial differences in the baseline characteristics, defined as standardized differences >0.1 in the stratification. Both treatment groups had similar mean change in CDAI at 6 months (–11.3 in ABA vs –9.9 in TCZ; mean difference –1.27, 95% CI –3.65, 1.11). Similar proportions of both treatment groups achieved low disease activity/remission (adjusted odds ratio for ABA vs TCZ 0.99, 95% CI 0.69, 1.43). Mean change in mHAQ was –0.12 in ABA initiators vs –0.11 in TCZ initiations (mean difference –0.01, 95% CI –0.09, 0.06).ConclusionsPatients receiving either ABA or TCZ had substantial improvement in clinical disease activity. In this propensity score-matched sample, similar outcomes were observed for both treatment cohorts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1179-7) contains supplementary material, which is available to authorized users.

Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis -The ANSWER cohort study-

“…Finally, with respect to the total drug persistency, Jones et al showed that treatment persistence was longer on ABT or TCZ followed by TNFi [33], and we have also reported that both ABT and TCZ showed higher retention rate compared with other TNFi in all ages [20]. Concerning patients with TNFi failure, both ABT and TCZ showed similar substantial improvement in clinical disease activity [34], and also good retention rates [35]. Concerning TNFi, a recent report demonstrated that GLM showed higher persistency compared with other TNFi when matched with propensity score in Japanese RA patients [36].…”

Drug retention of 7 biologics and tofacitinib in biologics-naïve and biologics-switched patients with rheumatoid arthritis: the ANSWER cohort study

“…Patients with first TNFi failure, switching to non-TNFi bDMARDs showed higher retention rates due to lack of effectiveness compared with patients switched to a second TNFi [9]. In such cases, both ABT and TCZ resulted in substantial improvement in clinical disease activity [39] along with good retention rates [40]. In terms of a JAK inhibitor, TOF showed a lower discontinuation rate due to lack of efficacy and an equivalent rate of adverse events compared with ABT, GLM, and TCZ [41].…”

Comparative effectiveness of rituximab, abatacept, and tocilizumab in adults with rheumatoid arthritis and inadequate response to TNF inhibitors: prospective cohort study

“…However, these studies had limited population samples, compared disease activity in the short term, and had discrepant results. 18 19 20 21 22 Registry data on the retention rate of non-TNF targeted biologics, notably rituximab and tocilizumab, is limited. In a recent collaboration between nine European registries, including the French registry, the median crude retention rate for abatacept varied from 1.4 to 2.1 years depending on autoantibody status, 23 which is similar to the median abatacept retention rate in the present study.…”