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11.03.2020 | Original Article

Drug retention of secondary biologics or JAK inhibitors after tocilizumab or abatacept failure as first biologics in patients with rheumatoid arthritis -the ANSWER cohort study-

verfasst von: Kosuke Ebina, Toru Hirano, Yuichi Maeda, Wataru Yamamoto, Motomu Hashimoto, Koichi Murata, Tohru Takeuchi, Koji Nagai, Yonsu Son, Hideki Amuro, Akira Onishi, Sadao Jinno, Ryota Hara, Masaki Katayama, Keiichi Yamamoto, Atsushi Kumanogoh, Makoto Hirao

Erschienen in: Clinical Rheumatology | Ausgabe 9/2020

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Abstract

Objectives

The aim of this multicenter, retrospective study was to clarify the retention of secondary biological disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (JAKi) in patients with rheumatoid arthritis (RA) who were primarily treated by tocilizumab (TCZ) or abatacept (ABT) as first bDMARDs.

Method

Patients who were treated by either TCZ (n = 145) or ABT (n = 76) and then switched to either tumor necrosis factor inhibitors (TNFi), TCZ, ABT, or JAKi (including only cases switched from TCZ) from 2001 to 2019 (female 81.0%, age 59.5 years, disease duration 8.8 years; rheumatoid factor positivity 75.4%; Disease Activity Score in 28 joints using C-reactive protein 3.7; concomitant prednisolone (PSL) dose 6.0 mg/day (51.8%) and methotrexate (MTX) dose 8.0 mg/week (56.1%); 81.9% discontinued first bDMARDs due to lack of effectiveness) were included. Drug retention and discontinuation reasons were estimated at 24 months using the Kaplan-Meier method and adjusted for potential confounders by Cox proportional hazards modeling.

Results

Drug retentions for each of the reasons for discontinuation were as follows: lack of effectiveness in TCZ-switched group (TNFi (59.5%), ABT (82.2%), and JAKi (84.3%); TNFi vs. ABT; P = 0.009) and ABT-switched group (TNFi (79.6%) and TCZ (92.6%); P = 0.053). Overall retention excluding non-toxic reasons and remission for discontinuation were TNFi (49.9%), ABT (72.7%), and JAKi (72.6%) (TNFi vs. ABT; P = 0.017) in the TCZ-switched group and TNFi (69.6%) and TCZ (72.4%) (P = 0.44) in the ABT-switched group.

Conclusions

Switching to ABT in TCZ-treated patients led to higher retention as compared with TNFi. Switching to TCZ in ABT-treated patients tended to lead to higher retention due to effectiveness, although total retention was similar as compared with TNFi.

Key Point

• This is the first retrospective, multi-center study aimed to clarify the retention rates of secondary bDMARDs or JAKi in patients with RA who were primarily being treated by TCZ or ABT as the first bDMARDs.

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Titel: Drug retention of secondary biologics or JAK inhibitors after tocilizumab or abatacept failure as first biologics in patients with rheumatoid arthritis -the ANSWER cohort study-
verfasst von: Kosuke Ebina
Toru Hirano
Yuichi Maeda
Wataru Yamamoto
Motomu Hashimoto
Koichi Murata
Tohru Takeuchi
Koji Nagai
Yonsu Son
Hideki Amuro
Akira Onishi
Sadao Jinno
Ryota Hara
Masaki Katayama
Keiichi Yamamoto
Atsushi Kumanogoh
Makoto Hirao
Publikationsdatum: 11.03.2020
Verlag: Springer International Publishing
Erschienen in: Clinical Rheumatology / Ausgabe 9/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-05015-5

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Drug retention of secondary biologics or JAK inhibitors after tocilizumab or abatacept failure as first biologics in patients with rheumatoid arthritis -the ANSWER cohort study-

Abstract

Objectives

Method

Results

Conclusions

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