Session Information
Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Treatment of rheumatoid arthritis (RA) has been revolutionized by the introduction of Tumour Necrosis Factor alpha inhibitors (TNFi). However a significant proportion of patients fails to respond (primary failure) or may lose the initial response over time (secondary failure). Whether a second TNFi or Biologics with Different Mode of Action [ BDMA; Rituximab (RTX), Abatacept (ABT), Tocilizumab (TCZ)] should be used, who had secondary failure still needs to be defined. The aim was to retrospectively compare the efficacy of second TNFi versus BDMA after secondary failure and to investigate whether there was an association between response and antibody status [Rheumatoid Factor (RF) and Anti CCP].
Methods:
This was a retrospective observational real life data analysis from two hospitals of North-East London serving diverse ethnic population. The list of the RA patients (defined by 2010 ACR/EULAR criteria), who had secondary failure to first line TNFi from 2010 to 2016, was obtained. The study population were randomly selected using ‘RESEARCH RAMDOMIZER’ software. Response to treatment was defined as the achievement of at least moderate response at six months according to EULAR response criteria.
Results:
A total of 422 patients were included in the analysis: 211 in each group (TNFi and BDMA). Male/female ratio was 1:3 and the mean age was of 61.4 years (SD ± 12.1). Baseline DAS28 (SD) scores were higher in BDMA group than in the TNFi group: [5.90(0.6) vs 5.20(0.8); p<0.01].
Table 1 describes response rates according to biologic subcategories and autoantibody status. This reflects 74 patients responded to second TNFi (35%) compared to 148 patients who responded in the BDMA group (70%) (p<0.01); Number need to treat (NNT) was 2.9. The response rates were better in seropositive if receiving RTX (85%) or TCZ (68%), while poorer on ABT (46%), p<0.01. In contrast, for seronegative patients RTX response was poor (35%), but markedly better response observed on ABT or TCZ (83% and 74% respectively).
Table 1: Comparison between TNFi and different BDMA according antibody status [Rheumatoid Factor (RF) and Anti CCP]
|
Total (N=422) |
TNFi (N=211) |
BDMA (N=211) |
p Value |
RTX (N=99) |
ABT (N=55) |
TCZ (N=57) |
p Value |
|
Responders (%) |
74(35%) |
148 (70%) |
<0.01 |
74 (75%) |
36 (65%) |
40 (70%) |
0.90 |
|
Sero (+) ( %) : Sero (-) (%) |
134(63%) :77(37%) |
130(62%) :81(38%) |
0.80 |
73 (74%) : 26 (26%) |
26 (47%) : 29 (53%) |
31 (54%) : 26 (46%) |
0.01 |
|
Sero (+) Responders (%) |
48 (36%) |
98(75%) |
<0.01 |
62(85%) |
12(46%) |
21(68%) |
<0.01 |
|
Sero (-) Responders (%) |
26 (34%) |
50 (61%) |
0.01 |
9 (35%) |
24(83%) |
17 (74%) |
<0.01 |
Footnote: Sero (+) = seropositive, Sero (-) = seronegative, N= number.
Conclusion:
RA patients who had secondary failure to the initial TNFi, had greater response rate (nearly 3:1), if treated with a BDMA instead of another TNFi. Our findings suggest that seropositive patients may be benefitted from switching to RTX or TCZ, meanwhile seronegative patients may do better with ABT or TCZ.
To cite this abstract in AMA style:
Shipa M, Di Cicco M, Balogh E, Mian A, Mukerjee D, Roussou E. Tailoring Second-Line Biologic Therapy in Rheumatoid Arthritis: New Findings on the Usefulness of Antibody Status to Optimise Drug Selection [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/tailoring-second-line-biologic-therapy-in-rheumatoid-arthritis-new-findings-on-the-usefulness-of-antibody-status-to-optimise-drug-selection/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tailoring-second-line-biologic-therapy-in-rheumatoid-arthritis-new-findings-on-the-usefulness-of-antibody-status-to-optimise-drug-selection/