Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Tocilizumab(TCZ) and other biologics are expensive and switching between them is difficult. The goal of this retrospective chart analysis is to identify the discontinuation rate of TCZ therapy in patients who have rheumatoid arthritis and to identify characteristics of patients who are able to continue TCZ in nonacademic settings.
Methods:
We conducted a review of all patients who received TCZ therapy in our office. Patients were excluded if they were part of the initial TCZ studies, had missing records, left the practice or treated for conditions other than rheumatoid arthritis. All other patients were included. The primary endpoint was the rate of discontinuation of TCZ. The secondary endpoint was to identify the differences in characteristics of patients who discontinued versus continued TCZ therapy.
Results:
104 charts were reviewed and 26 excluded. 59.6% (62/104, 95%CI 50%-69%) of all patients on TCZ therapy discontinued the medication. The most common reasons for discontinuation were ineffectiveness and adverse events. Table 1 describes the characteristics of patients who continued and those who discontinued TCZ use. A higher percentage of patients were on methotrexate in the group who continued TCZ (42.9%) as compared to the group who discontinued TCZ (24.2%, p=0.0242). Prednisone dosage after TCZ use was statistically significant between those who discontinued TCZ and those who continued TCZ, 9.10mg and 4.65mg respectively with a p value of 0.016. In patients who continued TCZ and those who discontinued TCZ HAQ scores (0.929 and 1.237, p=0.009), ESR levels (4.81 and 11.14, p=0.027) and CRP levels (0.18 and 1.15, p= 0.002) after TCZ therapy were statistically different.
Conclusion:
We found a higher rate of discontinuation compared to those reported in literature. TCZ discontinuation rates in clinical registries from Japan and Denmark were 30.4-42%1-2. The higher rate of discontinuation of TCZ in our study could be because of different clinical practices in nonacademic setting in the USA. We found that patients who continued TCZ therapy did show improvement in HAQ scores, ESR and CRP levels that were statistically different from patients who discontinued TCZ therapy. HAQ scores, ESR and CRP levels may be important predictors of response to TCZ therapy.
Table 1 Characteristics of patients who continued and discontinued Tocilizumab
|
|
Continued Tocilizumab (N=42) |
Discontinued Tocilizumab (N=62) |
P value |
|
Female gender |
40.5% (34) |
59.5% (50) |
0.97 |
|
Male gender |
40% (8) |
60% (12) |
0.97 |
|
Age |
58.98 |
60.23 |
0.62 |
|
Duration of disease (years) |
2.87 |
3.09 |
0.164 |
|
Rheumatoid Factor positive |
44.4% (16) |
55.6% (20) |
0.784 |
|
Rheumatoid Factor negative |
41.5% (22) |
58.5% (31) |
0.784 |
|
Anti-CCP positive |
43.8% (14) |
56.3% (18) |
0.86 |
|
Anti-CCP negative |
41.8% (23) |
58.2% (32) |
0.86 |
|
HAQ score prior to tocilizumab (mean) |
1.045 |
1.281 |
0.126 |
|
HAQ score after tocilizumab use (mean) |
0.929 |
1.278 |
0.009 |
|
ESR prior to tocilizumab use (mean) |
23.91 |
20.03 |
0.433 |
|
ESR after tocilizumab use (mean) |
4.81 |
11.14 |
0.027 |
|
CRP prior to tocilizumab use (mean) |
1.96 |
5.04 |
0.064 |
|
CRP after tocilizumab use (mean) |
0.18 |
1.15 |
0.002 |
|
Methotrexate prior to tocilizumab use (mean) |
15mg |
13.67mg |
0.23 |
|
Methotrexate use (%) prior to tocilizumab |
42.9% |
24.2% |
0.024 |
|
Methotrexate after tocilizumab use (mean) |
14.38mg |
14.11mg |
0.43 |
|
Prednisone dosage prior to tocilizumab use (mean) |
9.94mg |
7.97mg |
0.14 |
|
Prednisone dosage after tocilizumab use (mean) |
4.65mg |
9.10mg |
0.016 |
|
Number of prior biologics used |
2.21 |
2.45 |
0.26 |
|
|
|
|
|
HAQ health assessment questions, ESR erythrocyte sedimentation rate, CRP c-reactive protein
Reference: 1.Sakai R, Tanaka M et al. Drug retention and relevant risk factors for drug discontinuation due to adverse events in rheumatoid arthritis patients receiving anticytokine therapy with different target molecules. Ann Rheum Dis 2012;71:1820-1826, 2. Leffers, Ostergaard et al. Efficacy of abatacept and tocilizumab in patients with rheumatoid arthritis treated in clinical practice: results from the nationwide Danish DANBIO registry. Ann Rheum Dis.2011;70:1216-1222
Disclosure:
J. Manohar,
None;
C. H. Pritchard,
Genentech, Pfizer, Abvie,
8.
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