ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 713

Predictors of Treatment Retention Among Patients with Rheumatoid Arthritis or Ankylosing Spondylitis Treated with Remicade® (Infliximab) for Long-Term in Canadian Real-World

Michael Starr1, Edward Keystone2, Rafat Faraawi3, Louis Bessette4, Boulos Haraoui5, Wojciech Olszynski6, John Kelsall7, Raman Joshi8, Andrew Chow9, Algis Jovaisas10, J Carter Thorne11, Emmanouil Rampakakis12, Eliofotisti Psaradellis13, Marilise Marrache14, Brendan Osborne15, Karina Maslova16, Francois Nantel17, Allen J Lehman16 and Cathy Tkaczyk15, 1Rheumatology, Mcgill University, Pointe-Claire,, QC, Canada, 2Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada, 3McMaster University, Hamilton, ON, Canada, 4Rheumatology, CHUL de Quebec, Quebec, QC, Canada, 5Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada, 6103 Midtown Professional Center, Rheumatology Associates of Saskatoon, Saskatoon, SK, Canada, 7Mary Pack Arthritis Centre, Vancouver, Vancouver, BC, Canada, 8William Osler Health Centre-Brampton Civic Hospital, Brampton, ON, Canada, 9Credit Valley Rheumatology, Mississauga, ON, Canada, 10Capital North Therapeutics & Research, Ottawa, ON, Canada, 11Southlake Regional Health Centre, Newmarket, ON, Canada, 12JSS Medical Research, St-Laurent, QC, Canada, 13JSS Medical Research, Montreal, QC, Canada, 14Medical Affairs, Janssen Inc, Toronto, ON, Canada, 15Medical Affairs, Janssen Inc., Toronto, ON, Canada, 16Janssen Inc., Toronto, ON, Canada, 1719 Green belt Dr, Janssen Inc., Toronto, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Remission has become a target to achieve in rheumatic diseases and it also could be linked to treatment retention. The aim of this analysis was to identify independent predictors of retention in patients with RA or AS treated with infliximab (IFX).

Methods: BioTRAC is an ongoing, prospective registry of patients (pts) treated with IFX or golimumab. This analysis included RA and AS pts treated with IFX, and that had at least 2 years of follow-up. Independent predictors of retention were assessed with multivariate cox regression. Receiver operator curve (ROC) analysis was used to determine the optimal cut-off points of CDAI and ASDAS for long-term retention.

Results: A total of 490 RA and 201 AS pts were included in the analysis. Table 1 summarizes the disease parameters and characteristics at IFX initiation. With respect to disease activity, mean CDAI score was 35.9 in RA pts and ASDAS was 3.8 in the AS group. Table 2 presents the probability of retention over time by indication. In univariate analysis, among RA pts at baseline (BL): CDAI [HR (95% CI): 0.99 (0.99-1.00)], DMARD use [HR (95% CI): 0.70 (0.51-0.97)], steroid use [HR (95% CI): 1.23 (0.99-1.52)], at 24 months: CDAI [HR (95% CI): 1.02 (1.00-1.03)], and DMARD use [HR (95% CI): 0.82 (0.66-1.01)] were identified as potential predictors (P<0.150) of retention. No significant impact was observed for age, gender, disease duration, prior biologic experience, enrolment period, and steroid use at 24 months. In multivariate analysis, CDAI score at 24 months was the only significant (P=0.013) independent predictor of treatment retention [HR (95% CI): 1.02 (1.00-1.03)]. ROC analysis showed that the optimal 24-month CDAI cut-off score for downstream (non-)discontinuation was 11.7. In AS pts, ASDAS levels at 24 months were the only significant predictor of subsequent treatment discontinuation, with higher ASDAS score being associated with an increased hazard for discontinuation [HR (95% CI): 1.63 (1.12-2.38)]. Maintaining an ASDAS score of 2.7 or less at 24 months was associated with optimal retention on treatment long-term.  Table 1. Baseline Disease Parameters and Patient Characteristics

 

RA

(N=490)

AS

(N=201)

Age, years, mean (SD)

56.4 (13.0)

46.8 (11.8)

Disease duration, years, mean (sd)

9.4 (9.5)

9.8 (10.0)

Female gender, %

73.9%

35.1%

Enrolment period, n (%)

2002-2004

43.1%

0.0%

2005-2007

25.5%

40.8%

2008-2014

31.4%

59.2%

Biologic naïve, n (%)

90.0%

91.5%

DAS28

5.8 (1.5)

CDAI

35.9 (16.8)

28-SJC

12.5 (8.1)

28-TJC

10.8 (7.3)

HAQ-DI

1.63 (0.72)

1.22 (0.64)

ASDAS

3.8 (1.0)

BASDAI

6.4 (2.1)

Table 2. Kaplan-Meier Survival Point Estimates* of Retention

 

Retention Probability (%)

Time point (months) post 2 years of stable treatment

RA

(N=490)

AS

(N=201)

6

92%

94%

12

85%

89%

18

76%

85%

24

71%

79%

30

66%

73%

36

62%

70%

42

59%

65%

 * Values represent n at risk, retention probability (standard error)

Conclusion: Results have shown that, among pts remaining on IFX after 2 years, disease activity at 2 years is the single determinant of subsequent long-term retention on IFX treatment both in RA and AS pts, highlighting the importance of the treat-to-target strategy to achieve remission but also maintaining it over time in order to ensure optimal treatment benefits.

Disclosure: M. Starr, Janssen Inc., 5; E. Keystone, Abbott, AstraZeneca, Biotest, BMS, Crescendo, Hoffmann-LaRoche, Genentech, Janssen Inc, Eli Lilly and Company, Merck, Pfizer, UCB, 5; R. Faraawi, Janssen Inc., 5; L. Bessette, Janssen Inc., 5; B. Haraoui, Janssen Inc., 5; W. Olszynski, Janssen Inc., 5; J. Kelsall, Janssen Inc., 5; R. Joshi, Janssen Inc., 5; A. Chow, Janssen Inc., 5; A. Jovaisas, Janssen Inc., 5; J. C. Thorne, Janssen Inc., 5; E. Rampakakis, employee of JSS Medical Research, 3; E. Psaradellis, employee of JSS Medical Research, 3; M. Marrache, Employee of Janssen Inc., 3; B. Osborne, Employee of Janssen Inc., 3; K. Maslova, Employee of Janssen Inc., 3; F. Nantel, Employee of Janssen Inc., 3; A. J. Lehman, Employee of Janssen Inc., 3; C. Tkaczyk, Employee of Janssen Inc., 3.

To cite this abstract in AMA style:

Starr M, Keystone E, Faraawi R, Bessette L, Haraoui B, Olszynski W, Kelsall J, Joshi R, Chow A, Jovaisas A, Thorne JC, Rampakakis E, Psaradellis E, Marrache M, Osborne B, Maslova K, Nantel F, Lehman AJ, Tkaczyk C. Predictors of Treatment Retention Among Patients with Rheumatoid Arthritis or Ankylosing Spondylitis Treated with Remicade® (Infliximab) for Long-Term in Canadian Real-World [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/predictors-of-treatment-retention-among-patients-with-rheumatoid-arthritis-or-ankylosing-spondylitis-treated-with-remicade-infliximab-for-long-term-in-canadian-real-world/. Accessed .

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