The comparative effectiveness of abatacept versus anti-tumour necrosis factor switching for rheumatoid arthritis patients previously treated with an anti-tumour necrosis factor

Abstract

ObjectiveWe 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.MethodsWe 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.ResultsThe 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).ConclusionsRA patients with prior anti-TNF exposures had similar outcomes if they switched to a new anti-TNF as compared with initiation of ABA.

Design characteristics of the Corrona Japan rheumatoid arthritis registry

“…In addition, patient-reported outcomes (PRO) will be collected via instruments including the EQ-5D, HAQ-DI, and WPAI questionnaire ( Table 2). These data support robust comparative effectiveness studies, which have provided US rheumatologists with insights on the comparative effectiveness of abatacept and rituximab versus anti-TNF switching from the Corrona US registry [4,8].…”

Real-world evaluation of TNF-inhibitor utilization in rheumatoid arthritis

“…One study assessing the impact of treatment-switching patterns found similar outcomes for patients switching to an alternative TNFi compared with those switching to a non-TNFi biologic DMARD. 10 Others have shown that the likelihood of responding to future treatments decreases with every subsequent TNFi treatment initiation 11 and that switching to a non-TNFi biologic DMARD may be more effective for patients with TNFi non-response. 12 One potential explanation for these observations could be the different mechanisms behind individual patient inadequate response to TNFi.…”

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

“…There have been inconsistent results regarding the benefits of changing mechanism of action in observational data as a general approach, or whether targeting a specific pathway after failure of a TNFi will optimize outcomes. For example, improved outcomes were demonstrated in comparisons of rituximab vs a subsequent TNFi [11–14] but not in abatacept (ABA) initiators vs a subsequent TNFi [15]. More recently a RCT found greater effectiveness with use of non-TNFi biologics as compared with a second anti-TNF drug in TNF inadequate responders [16].…”

“…To address the limitations of observational studies, such as selection bias, propensity score methodology is commonly employed [15, 18, 19]. We used propensity score matching to compare the clinical effectiveness of tocilizumab (TCZ) vs ABA among RA patients with previous anti-TNF exposure in a large US cohort of RA patients using the Consortium of Rheumatology Researchers of North America (Corrona) registry.…”