Among seven biologic treatments for rheumatoid arthritis, tocilizumab exhibited the lowest discontinuation rate due to lack of effectiveness, while abatacept had the lowest rate based on toxic adverse events and achieved the lowest overall discontinuation rate, according to recent data in Arthritis Research & Therapy.
“Drug retention in observational studies is considered an index of safety, effectiveness and tolerability,” Kosuke Ebina, PhD, MD, of Osaka University in Japan, and colleagues wrote. “Treatment selection and discontinuation may be influenced by factors such as differences among attending physicians and patient characteristics in observational studies, although the national health insurance in our country and multicenter studies may help to decrease these possible bias ([biologic] DMARDs can be freely selected by attending physicians’ discretion in our country).”
To analyze the retention rates of, and the reasons for discontinuing, seven biologic DMARDs among patients with RA in a real-world setting, Ebina and colleagues studied data from the Kansai Consortium for Well-being of Rheumatic Disease Patients (ANSWER) cohort. According to the researchers, ANSWER is a multicenter registry of patients with RA at seven institutions in the Kansai district of Japan. It includes 4,461 patients with RA who were registered from 2009 to 2017, as well as 52,654 serial disease activities available.
Among seven biologics for RA, tocilizumab exhibited the lowest discontinuation rate due to lack of effectiveness, while abatacept had the lowest rate based on toxic adverse events, and achieved the lowest overall discontinuation rate, according to recent data.
The researchers included data from 2,494 patients, including 4,466 treatment courses, from January 2009 to September 2017. There were a total of 895 tocilizumab (Actemra, Genentech) treatment courses, 891 with etanercept (Enbrel, Amgen), 748 with infliximab (Remicade, Janssen), 681 with abatacept (Orencia, Bristol Myers Squibb), 558 with adalimumab (Humira, AbbVie), 464 with golimumab (Simponi, Janssen) and 229 with certolizumab pegol (Cimzia, UCB).
Ebina and colleagues estimated 36-month retention and discontinuation rates using the Kaplan-Meier method, and adjusted for age, sex, concomitant prednisolone and methotrexate, disease duration and switched number of biologic DMARDs using Cox proportional hazards models.
According to the researchers, 56.9% of treatment courses were discontinued. Among these cases, 25.8% were ceased due to lack of effectiveness, 12.7% due to non-toxic reasons, 11.9% due to toxic adverse events and 6.4% due to remission. Drug retention rates, based on reason for discontinuation, ranged from 65.5% for infliximab to 81.7% for tocilizumab, due to lack of effectiveness (P<.001); from 81.8% for infliximab to 94% for abatacept, due to toxic adverse events (P<.001); and from 92.4% for adalimumab and infliximab to 97.7% for etanercept, for remission (P<.001).
Overall retention rates, excluding cases in which a drug was discontinued to nontoxic or remission-related reasons, ranged from 53.4% for infliximab to 75.5% for abatacept (P<.001).
“The strengths of this study were relatively a large number of treatment courses of seven [biologic] DMARDs, and that treatment choice and discontinuation judgments were based on a real-world setting,” Ebina and colleagues wrote. “[Tocilizumab] showed the lowest discontinuation rate by lack of effectiveness, [abatacept] showed the lowest discontinuation rate by toxic adverse events, [adalimumab] and [infliximab] showed the highest discontinuation rate by remission, and [abatacept] showed the highest overall retention rate (excluding non-toxic reasons and remission) among seven [biologic] DMARDs in adjusted model.” – by Jason Laday
Disclosures : Ebina reports research grants and/or speaking fees from Abbvie, Asahi-Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lily, Mitsubishi-Tanabe, Ono Pharmaceutical, Pfizer, Taisho-Toyama, and UCB Japan. Please see the full study for additional authors’ disclosures.