According to a recently published study, both older age and the presence of comorbidities influence a physician’s choice of abatacept when the other choice is a tumor necrosis factor inhibitor.
“[Our] real-life study demonstrated that age, infectious risk, the number and type of comorbidities and monotherapy are the main factors influencing the choice of the biologic drug in real life, driving the choice toward [abatacept] ABA or [tocilizumab] TCZ compared to [tumor necrosis factor inhibitor] TNFi,” Sara Monti, in the Department of Rheumatology at the University of Pavia in Italy, and colleagues wrote. “The interruption of previous [biologic disease-modifying anti-rheumatic drugs] bDMARDs due to [adverse events] AE influenced the choice toward ABA.”
Monti and colleagues determined which factors influence a physician’s first-line choice or switch strategy of biologics, specifically ABA and TCZ vs. TNFi. The researchers included 1,910 patients enrolled in the Lombardy Rheumatology Network (LORHEN) Registry, which began in 2010. The researchers categorized the patient population into first-line (n = 1,264) and second-line bDMARD (n = 646).
The researchers found age was older in the ABA and TCZ groups vs. the TNFi group; methotrexate combination therapy was lower in the TCZ group. They also discovered the type of comorbidity — whether it was dyslipidemia, hypertension or pulmonary disease — and the number of these influenced the choice toward ABA.
In addition, they found TCZ was associated with second-line treatment, older age and more severe disease activity and ABA was associated with second-line treatment, older age, dyslipidemia, pulmonary disease, extra-articular manifestations and cessation of the first bDMARD due to adverse events. In the case of cessation of previous treatment due to AEs, ABA was preferred to TNFi.
“After failing a first-line TNFi, a strategy of swapping to a different [mechanism of action] MoA is usually more common,” the researchers wrote. – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.