Session Type: Abstract Submissions (ACR)
Background/Purpose: Combination therapy (Biologic+non-biologic (nb)DMARDs) is the recommended therapeutic strategy in biologic-based RA treatment. However, biologics in montherapy represent around 30% of the biologic-treated patients (1-3).
Objectives: Evaluate in a real life setting the rate of patients treated with biologics as monotherapy (Mono) vs in combination with a nbDMARD (Combo) and compare the characteristics of these two populations.
Methods: 15-week prospective survey among 121 French representative rheumatologists (region and activity) treating RA patients with biologics in Mono or in Combo. Each physician completed a short record-sheet for biologic-treated RA patients seen in Q4 2012 (CENSUS). A more detailed record sheet was filled-in for the 5 next Mono patients and the 5 next Combo patients (FOCUS). Reported data were patients’ and disease characteristics, current and previous treatment and therapeutic strategy.
Results: 1949 patients were included in the CENSUS . Patients characteristics were as followed: mean age 54,2 years, 72% female, mean disease duration 12,5 years, 81% ACPA positive and 68% erosive RA. Regarding disease activity, 40% were in DAS28 remission (<2,6) and 36% presented a low disease activity (DAS<3,2).The survey showed that 34% (n=662) of these patients were on biologic Mono. Patients treated by an office-based rheumatologist (n=404) were more often on a biologic in Mono (43% vs 32%, p<0.01) than patients treated at hospital. No differences in terms of patients characteristics were observed between Mono and Combo patients except for a negative ACPA serology (22% Mono patients vs 14% Combo, p<0.01) and corticosteroids which were more frequently used in Mono patients (64% vs 58%, p=0.02). The main biologics prescribed in Combo were Etanercept (ETN, 35%) and Adalimumab (ADA, 24%) and in Mono ETN (34%), ADA (23%) and Tocilizumab (TCZ, 19%). Compared to the other biologics, TCZ appeared to be more frequently used in Mono than in Combo with 54% of TCZ-patients treated in Mono vs 33% for both ETN- and ADA-patients. The survey also showed that among patients treated with a biologic without Mono label, approximately 1/3 received it in Mono. The majority (86%) of Combo patients were on MTX at a median dosage of 15mg/week. The FOCUS included 445 patients on Combo and 369 patients on Mono, who were representative of the CENSUS patients (no difference observed between both parts). For patients treated currently with a biologic in Mono, main reasons for stopping DMARDs were: intolerance 43%, lack of efficacy 31%, remission 18%, and patients’ refusal 12%.
Conclusion: This survey showed that in a French real life clinical practice, 34% of RA patients treated with a biologic received it in Mono. This result is concordant with French and European registries (1-3) data. Surprisingly, no relevant difference was observed in terms of characteristics between patients treated in Mono and patients treated in Combo, except for ACPA status.
1. Mariette X, et al. Rheumatology 2011;50:222–229
2. Soliman M, et al. Ann Rheum Dis 2011;70:583–589
3. Listing J, et al. Arthritis Res Ther 2006
Roche, Pfizer, BMS,
Roche, Pfizer, BMS,
J. C. Balblanc,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-monotherapy-in-french-rheumatoid-arthritis-ra-patients-from-a-real-life-clinical-practice-compared-to-patients-treated-with-a-combination-therapy-biologic-dmard/