Real-World Persistence with Tocilizumab Compared to Other Subcutaneous Biologic Disease-Modifying Antirheumatic Drugs Among Patients with Rheumatoid Arthritis Switching from Another Biologic

Abstract

Introduction: In patients with rheumatoid arthritis (RA) who have an inadequate response to or intolerance of their first biologic diseasemodifying antirheumatic drug (bDMARD), guidelines recommend switching to a different biologic class. The objective of this study was to compare persistence with subcutaneous (SC) tocilizumab to persistence with other SC bDMARDs when these drugs are used as subsequent-line therapy in RA patients who previously received C 1 bDMARD. Methods: RA patients in a US administrative claims database who initiated a second-or subsequent-line SC bDMARD between January 1, 2012 and June 30, 2017 (initiation date = index date) were included. Persistence was defined as the number of days between the bDMARD initiation date and (1) the last supplied day of medication fill (primary) or (2) the day on which the patient switched or there was a gap in treatment of [ 90 days (secondary). Parametric survival models utilizing an exponential distribution with a robust variance estimator were used to compare persistence with tocilizumab to persistence with other bDMARDs. Results: A total of 10,301 patients with 12,704 bDMARD episodes were included. Patients receiving tocilizumab had a significantly higher adjusted median (95% CI) number of days of primary persistence [333 (311-356)] than those receiving adalimumab [280 (268-293); P \ 0.001], certolizumab [262 (241-284); P \ 0.001], and etanercept [289 (274-304); P = 0.001], and a similar persistence to those receiving abatacept [320 (305-335); P = 0.327] and golimumab [304 (274-333); P = 0.122]. Conclusion: Among patients with RA who had previously received C 1 bDMARD, tocilizumabtreated patients exhibited a similar or significantly better biologic persistence than those receiving other bDMARDs.

A systematic literature review informing the consensus statement on efficacy and safety of pharmacological treatment with interleukin-6 pathway inhibition with biological DMARDs in immune-mediated inflammatory diseases

“… 180 181 Among patients with RA who had previously received ≥1 bDMARD, TCZ treated patients showed a similar or significantly better biological persistence than those receiving other bDMARDs. 182 Moreover, fatigue and physical function significantly improved in TCZ treated GCA-patients compared with those receiving steroids only. 183 In JIA, patients switching route of administration from intravenous to SC reported satisfaction in terms of life quality, school success and reduced school absenteeism.…”

“…In RCTs, TCZ and SAR monotherapy yielded greater improvements across multiple PROs than csDMARD or TNF-i (ADA) 180 181. Among patients with RA who had previously received ≥1 bDMARD, TCZ treated patients showed a similar or significantly better biological persistence than those receiving other bDMARDs 182. Moreover, fatigue and physical function significantly improved in TCZ treated GCA-patients compared with those receiving steroids only 183.…”

Predictive factors for effective selection of Interleukin-6 inhibitor and tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis

“…However, there are no established treatment guidelines for the selection of biologic drugs in individual patients based on their effectiveness. Tocilizumab and etanercept are commonly used as biological drugs for the treatment of RA 23,24 . Further, several reports showed the response to biological drugs was changed between the biologic treatment as the first drug and the treatment as the second drug because the immune response of the patient receiving second biologics may be altered after the first biological drug 25,26 .…”

Role of ACE2 receptor and the landscape of treatment options from convalescent plasma therapy to the drug repurposing in COVID-19

“…An anti-IL6 blocker targets the IL6 receptor proved to be effective in rheumatoid arthritis treatment [99], and later for juvenile idiopathic arthritis [100], giant cell arteritis [101]. IL6 is a bonafide marker for inflammation.…”