Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
We compared patient (pt) characteristics, for initiating, tapering and DC of TNFi/MTX combination therapy (CT), among RA pts seen during 02-04 vs. 07-09 to detect changes in practice.
Methods:
In the Consortium of Rheumatology Researchers of North America (CORRONA), a rheumatoid arthritis (RA) registry, the relationship between maximum CDAI(Clinical Disease Activity Index) and the use of CT during the 2 time intervals was compared using all RA pts in CORRONA and those with >=2 yrs of follow-up (f/u) (N=4955; N= 6847). DC’ing/tapering MTX, TNFi, or both and reasons for DC’ing were compared among the subset who initiated CT (n=315; n=697 respectively).
Results:
Among pts receiving CT, age, gender and patterns of adding TNFi to MTX vs. MTX to TNFi were similar in the 2 time periods; The mean CDAI at CT initiation (for all pts and pts with >=2 yr f/u) was lower in 07-09 (18.6 and 18.3 vs. 14.6 and 14.0, p<0.001). 35% of all pts starting CT were on prednisone at initiation during the 02-04 interval vs. 30.4% during 07-09, p=0.084. Among all RA pts with 2 yrs of f/u a higher percentage of patients initiated CT in 07-09 than 02-04 in each maximum CDAI category. Although MTX DCing rates were similar between the 2 time periods, tapering was more frequent in the 07-09 (51%) vs 02-04 cohort (38.8%), p = 0.029. DCing (or switching) the TNFi occurred among 37% of pts initiating CT during 07-09 vs. 31.7% (02-04) p=0.105. Baseline CDAI did not predict DC patterns. The mean CDAI at time of DC was higher in the 02-04 cohort for MTX, TNFi or both with overall mean CDAIs (02-04 vs. 07-09) at the time of DC of CT of 19.4 vs. 13.2 p<0.001. The mean CDAI at time of DC of prednisone, was similar between the two time periods (15.2 vs. 15.0) p=NS.
Physician-recorded reasons for DC’ing MTX or TNFi were consistent across time intervals.
Conclusion:
We found lower CDAIs among those initiating CT between 07-09 and lower CDAIs among those weaning or stopping CT in 2 yrs of f/u, perhaps reflecting stricter definition and implementation of aggressive treatment goals in the later time periods.
|
RA pts with 2 yr F/U after a visit in |
2002-2004 |
2007-2009 |
Total |
|
N |
4955 |
6847 |
11,802 |
|
% of pts with a max CDAI during the 2 yr F/U who DID NOT receive CT anytime during the 2yr |
p-value |
||
|
Max CDAI 10-22 |
80.8 % |
74.3 % |
<0.001 |
|
Max CDAI >22 |
74.2 % |
71.1% |
0.038 |
|
RA pts with 2 yr F/U after initiating CT |
2002-2004 |
2007-2009 |
Total |
|
N |
315 |
697 |
1012 |
|
% of RA pts DCing CT during 2 yrs F/U |
p-value |
||
|
DC only MTX (continuing TNFi) |
15.2 % |
13.1 % |
0.350 |
|
DC only TNFi (continuing MTX) |
31.7 % |
37.0 % |
0.105 |
|
DC both MTX + TNFi |
7.9 % |
6.5 % |
0.390 |
|
DC Prednisone |
33.6 % |
43.5 % |
0.085 |
|
CDAI (SD) at time of DC of RA pts who DC |
p-value |
||
|
MTX only |
14.2 (11.0) |
10.6 (12.2) |
0.088 |
|
TNFi only |
20.5 ( 14.0) |
14.5 ( 13.0) |
<0.001 |
|
both MTX + TNFi |
25.1 (17.2) |
10.9 (10.1) |
<0.001 |
|
DC Prednisone |
15.2 (12.7) |
15.0 (15.0) |
0.951 |
Disclosure:
D. Wenkert,
Amgen,
1,
Amgen,
3;
S. Grant,
Axio Research LLC,
3;
D. H. Collier,
Amgen Inc.,
1,
Amgen Inc.,
3;
A. S. Koenig,
Pfizer Inc,
3,
Pfizer Inc,
1;
J. M. Kremer,
Bristol-Myers Squibb, Genentech, Pfizer, UCB, HGS,
2,
Amgen, Abbott, Genetech, Pfizer,
5,
Amgen, Abbott, BMS ,
8,
Corrona ,
4.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/2002-04-vs-2007-09-initiation-of-combination-and-taperingdiscontinuation-dc-patterns-of-tnfi-and-mtx-in-a-us-ra-patient-registry-analysis-with-cdai-scores/