Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: to analyze failure predictors to anti-tumor necrosis (TNF) therapy in patients who have switched these drugs during chronic arthritis treatment.
Methods: BIOBADASAR is a national registry from Argentina. Patients with Autoimmune Rheumatic Diseases are included with appropriate diagnostic criteria and different forms of chronic arthritis who are treatment with biological drugs (bDMARDs). A control population matched for diagnosis and demographic features, free of bDMARDs therapy is included. Using this registry, we have analyzed patient switching of TNF antagonists. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication.
Results: From August 2010 to January 2016, 3397 patients were registered with: RA 2745 (78.6%), PsA 395 (11.3%), JIA 150 (4.3%), AS 107 (3.07%); mean age: 57.1±14.8 yrs; 78.4% female. 1853/3397(54,5%) patients received a total of 2079 treatment cycles: Etanercept (ETA) was used in 1155 (55.6%), adalimumab (ADA) in 601 (28.9%), infliximab (INF) in 156 (7.5%), certolizumab in 118 (5.7%) and golimumab in 49 (2.4%). More than one anti TNF was used in 1520/1853 (82%) patients. The median survival time of TNF antagonists was 36 (range, 1-243) months. TNF antagonists were discontinued in 890 (42.8%) cycles. The reasons for discontinuation were inefficacy in 350 (39.3%), adverse events in 274 (30.8%), lack of drug provision by medical insurance in 173 (19.4%), lost to follow-up in 57 (6.4%), pregnancy in 15 (1.7%), unknown reasons in 13 (1.59%) and disease remission in 8 (0.9%) patients. ETA was discontinued in 502/1155 (45.4%), mostly 117 (23%) due to lack of insurance payment ((p=0.001), INF was discontinued in 54 (51.9%) due to persistently active disease (p=0.005). Survival of the first TNF antagonist after one year of treatment was slightly higher for certolizumab (0.85 (95% CI 0.77-0.91) and ETA (0.82, 95%CI 0.80-0.84)) compared to golimumab (95%CI 0.80, 0.65-0.89), ADA (0.79, 95%CI 0.76- 0.82) and INF (0.77, 95% CI 0.69-0.84). Among patients with concomitant use of MTX, 65.7% (585) were discontinued vs not in 830 (69.8%) (p=0.045); corticosteroids were discontinued in 50.8% vs not in 34.9% (p ≤ 0.00001). In a logistic regression model, predictors of discontinuation were: female (OR 1.59, 95% CI 1.26–2.00), ≥60 years old (OR 1.28, 95% CI 1.06–1.53), smoker (OR 1.51, 95% CI 1.11–2.05), use of corticosteroids (OR 1.97, 95% CI 1.62–2.38), INF (OR 8.73, 95% CI 5.17–14.7), ETA (OR 3.48, 95% CI 2.30–5.27) and ADA (OR 3.38, 95% CI 2.20–5.19). Concomitant use of MTX had a protective effect (OR 0.67, 95% CI 0.55–0.82).
Conclusion: We found higher rates of discontinuation of TNF antagonists in patients who used INF and ETA, including a higher frequency of discontinuation due to inefficacy in INF and lack of coverage by insurance in ETA. Specific analysis of failure predictors identified being a female, ≥60 years old, a smoker, and use of corticosteroids, INF, ETA and ADA as the main failure predictors of discontinuation of TNF antagonists in patients with chronic arthritis. On the other hand, the concomitant use of MTX had a protective effect.
To cite this abstract in AMA style:Haye Salinas MJ, Retamozo S, Alvarellos A, Caeiro F, Pirola JP, Baenas D, de La Vega MC, Casado G, Gomez G, Roberti J, Cerda OL, Gandino IJ, Quinteros A, Exeni I, Bande JM, Barreira JC, Gobbi C, Alvarez A, Granel A, Peluzzon A, Capuccio A, Nieto R, Quintana R, Mussano E, Scarafia S, Costi C, De La Sota M, Diaz MP, Velozo EJ, Aguero S, Battagliotti C, Soares de Souza S, Cavillon E, Bohr A, Smichowski A, Vidal D, Pereira D, Martinez L, Somma L, Zalazar M, Finucci Curi P, Carlevaris L, Berbotto G, Saurit V. Failure Predictors to Anti-Tumor Necrosis Antagonists in Patients with Chronic Arthritis: Results of a National Registry Biobadasar [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). http://acrabstracts.org/abstract/failure-predictors-to-anti-tumor-necrosis-antagonists-in-patients-with-chronic-arthritis-results-of-a-national-registry-biobadasar/. Accessed September 20, 2017.
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